VA Health Care First to have Centers for Medicare & Medicaid Services Codes for Chaplain Care

by Michael Skaggs, PhD

The Centers for Medicare and Medicaid Services (CMS) recently approved the creation of three new Healthcare Common Procedure Coding System (HCPCS) codes for chaplains providing spiritual care at the Department of Veterans Affairs (VA) Veterans Health Administration (VHA). This is the first time an organization has been granted these independent healthcare codes created for use by clinical chaplains in a stand-alone setting. More importantly, it represents an enormous leap forward in how the work of chaplains fits into the overall care of Veterans.

“This is a milestone development in the provision of spiritual care for Veterans,” said VA National Director of Chaplaincy Juliana Lesher, MDiv, PhD, BCC. “This is the first time chaplains have been granted clinical designation codes for spiritual care and that means spiritual care is formally recognized as a part of overall Veteran care.”

This development has been long in the making. Lesher first began working toward coded clinical designation of spiritual care in 2016. As a representative of the Association of Professional Chaplains (APC), she joined APC Chief Executive Officer Pat Appelhans in presenting their case to the American Medical Association (AMA). While that attempt was unsuccessful, with the AMA declining to provide a clinical code for spiritual care, the conversation had begun at a very high level. “We were there, and everyone saw and heard from us. At the medical community’s most significant annual meeting, it had become clear how significant spiritual care is to patients,” Lesher said.

Lesher took a different approach when she began leading Veterans Affairs Chaplains in 2019. “If the AMA wouldn’t give us a code, we decided to try and approach the Centers for Medicare and Medicaid Services.” The goal was to secure three specific clinical codes: one for spiritual assessment, individual spiritual care (including, significantly, spiritual care for Veterans’ families or caregivers) and group spiritual care. After nearly a year of discussions Lesher was invited to make a formal presentation to CMS in June of this year. Within weeks the Centers approved her request.

Chaplains being able to code their work with patients as a clinical service is far more than an administrative change. “As far as VA is concerned, chaplains are no longer part of the administrative team in a medical center. They are now recognized for providing Veterans clinical care,” Lesher explained. “This will mean Chaplains have a higher standard for employment with the VA. Board certification will become mandatory and treated as equivalent to state licensure for doctors and nurses.” The shift in how the VA understands chaplaincy has practical implications, as well. Chaplains’ work is now counted in the level of service provided by each individual medical center. The clinical chaplain workload will now be able to contribute to the Veterans Equitable Resource Allocation System, or VERA, the system by which Congress appropriates funding for VHA. Lesher emphasized these costs are not passed along to Veterans. “What chaplains do is now included in the clinical count workload of each medical center, but that work remains non-billable to Veterans.”

When asked if this development might influence how other organizations and systems incorporate chaplains, Lesher stressed the uniqueness of VHA. “What’s important is that at a very high level, concepts including clinical pastoral education, moral injury and other components of spiritual care are now understood in the context of all clinical care.” With this new understanding of spiritual care, the Lab and the field at large is eager to see how chaplains might be integrated into other communities in the future.

Shelley Varner Perez, MDiv, BCC, Senior Program Manager for Spiritual Care Research for the Academic Health Center and Indiana University health, contributed to this article.