Quick answer
Most CHAMPVA care does not require preauthorization. But some services need CHAMPVA approval before they are provided.
The current rule in 38 CFR § 17.273 requires preauthorization, unless the benefit is covered by the beneficiary's other health insurance, for:
- non-emergency inpatient mental health and substance use disorder care, including certain residential treatment-center admissions;
- all admissions to a partial hospitalization program, including alcohol rehabilitation;
- covered dental care, which is itself very limited under CHAMPVA; and
- organ transplants.
VA's current operational materials add useful detail. The currently linked CHAMPVA Guidebook also lists intensive outpatient programs (IOP) and applied behavior analysis (ABA) treatment, but not the ABA evaluation, among services requiring preauthorization. VA's current provider guidance describes the rule more broadly as applying to dental care, organ and bone marrow transplants, and most mental health or substance use services.
For ordinary CHAMPVA medical-service preauthorization, VA currently directs beneficiaries and providers to 833-930-0816. The Guidebook also lists VHAHAC.preauthorizationFM@va.gov for preauthorization requests.
The regulatory list in 38 CFR § 17.273
The regulation is the best starting point because it defines the core preauthorization categories.
Non-emergency inpatient mental health and substance use care
Advance approval is required for non-emergent inpatient mental health and substance use disorder care. The regulation specifically includes admission of emotionally disturbed children and adolescents to residential treatment centers.
VA's Guidebook gives more operational detail for behavioral health. It identifies acute inpatient psychiatric hospitalization, residential treatment, certain substance use treatment, partial hospitalization, and intensive outpatient treatment as areas where preauthorization may be required.
The word non-emergent matters. Do not delay emergency evaluation or stabilization merely to obtain a routine preauthorization. The rules for a missed authorization and later claim review are separate from the question of whether advance approval is normally required.
Partial hospitalization programs
The regulation requires preauthorization for all admissions to a partial hospitalization program, including alcohol rehabilitation.
The current Guidebook also identifies intensive outpatient programs (IOP) as requiring CHAMPVA preauthorization. IOP is not separately named in the text of § 17.273, so it is best understood as a current VA operational requirement rather than a separate item in the CFR list.
Dental care
CHAMPVA dental coverage is limited, but when dental care is covered, preauthorization is required.
The Guidebook says all CHAMPVA-covered dental care requires preauthorization and explains that covered dental treatment generally must be connected to the appropriate treatment of another covered medical condition.
Do not confuse CHAMPVA's limited medical-benefit dental coverage with separate dental insurance available through the VA Dental Insurance Program.
Organ and bone marrow transplants
The regulation lists organ transplants. VA's current provider guidance specifically describes preauthorization as required for organ and bone marrow transplants.
Because transplant care involves facility, professional, and coordination issues, the provider should confirm the approval requirements before non-emergency treatment begins.
Additional current VA operational preauthorization rules
The CFR list is not the only place VA publishes current preauthorization instructions.
Intensive outpatient behavioral health care
The current CHAMPVA Guidebook says preauthorization is required for Intensive Outpatient Programs (IOP) and Psychiatric Partial Hospitalization Programs (PHP), except when qualifying other health insurance is primary and has already authorized the care.
Applied behavior analysis treatment
The current Guidebook lists applied behavior analysis (ABA) for treatment only as requiring preauthorization. It expressly distinguishes the treatment from the ABA evaluation, which it does not list as requiring preauthorization.
Because ABA requirements can involve provider and treatment-plan details, confirm the current authorization requirements before treatment starts.
Some prescription drugs use a separate pharmacy prior-authorization process
VA's CHAMPVA provider page, last updated September 10, 2026, currently says Wegovy and Zepbound require prior authorization when covered for qualifying diagnoses. Those requests go to OptumRx at 844-403-1029.
That is a pharmacy prior-authorization workflow, not an expansion of the medical-service list in § 17.273. A medication can have its own pharmacy authorization rule even when the underlying office visit does not require CHAMPVA preauthorization.
When other health insurance has already authorized the care
Other health insurance can change the CHAMPVA preauthorization workflow.
The introductory language of § 17.273 makes the listed preauthorization requirement inapplicable when the benefit is covered by the beneficiary's other health insurance (OHI). The Guidebook puts this into operational terms: when OHI has authorized a service that is otherwise on CHAMPVA's preauthorization list, CHAMPVA does not require a separate preauthorization for that service.
But this is not permission to ignore the primary plan's rules. The Guidebook warns that if the other insurer denies coverage because its requirements were not followed or medical necessity was not established, CHAMPVA may also deny coverage.
A practical approach is to keep the primary plan's authorization and Explanation of Benefits documentation with the CHAMPVA claim records.
CITI exception
The Guidebook says services on its preauthorization list do not require separate CHAMPVA preauthorization when they are provided through the CHAMPVA In-House Treatment Initiative (CITI).
VA's current CHAMPVA care page similarly notes that certain care provided through CITI does not require approval first.
CITI is not available at every VA medical facility, and the services available depend on local capacity. Confirm CITI availability with the participating VA facility rather than assuming a community service is covered by the CITI exception.
How to request CHAMPVA preauthorization
For ordinary medical-service preauthorization, the current Guidebook lists these routes:
Phone: 833-930-0816
Email: VHAHAC.preauthorizationFM@va.gov
Mail:
VHA Office of Integrated Veteran Care
CHAMPVA Beneficiary Claims
P.O. Box 500
Spring City, PA 19475
VA's provider page also currently directs providers to 833-930-0816 to request preauthorization.
Before contacting VA, have the beneficiary and proposed care information available. The provider should be prepared to explain the service, diagnosis or clinical reason for the care, and supporting medical-necessity information when VA requests it.
For Wegovy or Zepbound, use the separate current pharmacy prior-authorization route identified by VA: OptumRx at 844-403-1029.
A practical preauthorization checklist
Before scheduled care, use this sequence:
- Identify the exact service and level of care. "Mental health treatment" is too broad; inpatient hospitalization, residential treatment, PHP, IOP, ordinary outpatient therapy, and ABA can have different rules.
- Check whether CHAMPVA is primary or secondary. If other health insurance is primary, follow that plan's authorization requirements first.
- Check the current VA rule, not an old handout. Current § 17.273 no longer contains the former numerical outpatient mental-health threshold found in older materials.
- Confirm whether the care is being provided through CITI. The Guidebook provides a preauthorization exception for listed services furnished through CITI.
- Use the correct authorization channel. Medical-service preauthorization and pharmacy prior authorization are not always handled through the same route.
- Keep the approval or other-insurance authorization record. Save the authorization number, correspondence, and supporting documents with the claim records.
- Verify coverage separately. Preauthorization does not replace the separate requirements for CHAMPVA eligibility, a covered benefit, medical necessity, provider qualification, and correct claim filing.
If a provider is asking for a "referral" rather than preauthorization, see Do You Need a Referral With CHAMPVA?. A clinical referral and CHAMPVA preauthorization are different requirements.
What if preauthorization was required but not obtained?
Do not assume a missed preauthorization can always be fixed after the service.
Section 17.273 contains a narrower retrospective medical-necessity review rule during coordination of benefits when CHAMPVA becomes the responsible payer, preauthorization was not obtained before the service, and the claim is filed within the applicable one-year period.
That provision is not a general promise that every unapproved service will be paid. If required authorization was missed, contact CHAMPVA promptly and keep the other-insurance records, medical documentation, and claim records together.
Avoid outdated preauthorization lists
CHAMPVA preauthorization rules have changed over time. In particular, the current § 17.273 does not contain the former rule requiring preauthorization after more than 23 outpatient mental-health visits per calendar year or more than two sessions per week.
For current care, use the current CFR, the current VA CHAMPVA pages, and the Guidebook that VA presently links—not an older fact sheet or saved handout.
This is also why VA's concise web pages and its more detailed Guidebook can look different: the web page summarizes the major categories, while the Guidebook gives operational detail such as IOP and ABA treatment.