38 CFR § 17.273 - Preauthorization.
Preauthorization or advance approval is required for any of the following, except when the benefit is covered by the CHAMPVA beneficiary's other health insurance (OHI):
(a) Non-emergent inpatient mental health and substance abuse care including admission of emotionally disturbed children and adolescents to residential treatment centers.
(b) All admissions to a partial hospitalization program (including alcohol rehabilitation).
(c) Outpatient mental health visits in excess of 23 per calendar year and/or more than two (2) sessions per week.
(d) Dental care. For limitations on dental care, see § 17.272(a)(21)(i) through (xii).
(e) Organ transplants.
(e) Organ transplants.
(f) CHAMPVA will perform a retrospective medical necessity review during the coordination of benefits process if:
(1) It is determined that CHAMPVA is the responsible payer for services and supplies but CHAMPVA preauthorization was not obtained prior to delivery of the services or supplies; and,
(2) The claim for payment is filed within the appropriate one-year period.