VA Community Care Vascular Surgery Costs Surge as PAD Referrals Nearly Triple Over Five Years
Key Insights
VA Community Care referrals for vascular surgery nearly tripled from 21,407 in FY2020 to 62,487 in FY2025, a 192% increase driven largely by peripheral artery disease (search) interventions.
Infrainguinal endovascular procedure payments more than quadrupled from $8.8 million to $40.2 million, with femoral-popliteal atherectomy as the highest-paid procedure code across nearly all years analyzed.
Distance from a VA facility accounted for 88% of community care referrals, and no open bypass or groin-level reconstruction procedures appeared among the top 30 paid codes.
BOSTON — Referrals for vascular surgery through the Department of Veterans Affairs (VA) Community Care program nearly tripled over five years, with endovascular interventions for peripheral artery disease (search) (PAD) dominating costs, according to a comprehensive analysis presented at the Society for Vascular Surgery Vascular Annual Meeting (VAM26) in Boston, June 10–13.
The study, titled "VA Community Care Vascular Surgery Costs are Dominated by Endovascular Interventions for Peripheral Artery Disease (search)," analyzed data from fiscal years 2020 through 2025 using the VA Community Care Referral (CCR) Dashboard and Integrated Informatics and Analytics. Researchers evaluated referral volume, justification for community care, cost, and total payment claims for Vascular Surgery-related Current Procedural Terminology (CPT) codes from all VA centers nationwide.
Referral Volume Surges Under MISSION Act
Community care referrals for vascular surgery rose from 21,407 in fiscal year 2020 to 62,487 in fiscal year 2025, representing a 192% increase over the study period. Distance from a VA facility was the most common reason for referral, accounting for 88% of cases — or seven out of every eight referrals — a finding consistent with the geographic distribution of the veteran population and the specialized nature of vascular surgical care.
The growth coincides with the 2019 implementation of the MISSION Act, which expanded veterans' access to care outside VA facilities. More than 180,000 veterans receive care for PAD within the VA healthcare system, and veterans face elevated PAD risk due to higher rates of smoking, diabetes, and hypertension compared with the general population. PAD affects more than 200 million people worldwide and can progress to chronic limb-threatening ischemia (search) (CLTI), a severe condition carrying a high risk of amputation and death.
Endovascular Interventions Drive Cost Growth
Endovascular interventions dominated the cost picture throughout the study period. Femoral-popliteal atherectomy, a minimally invasive procedure to remove plaque from leg arteries, was the highest-paid procedure code in nearly every year analyzed, with payments increasing from approximately $4.5 million to $9.9 million. Payments for iliac endovascular interventions grew from $1.65 million to $5.6 million, while total payments for all infrainguinal endovascular interventions more than quadrupled, rising from $8.8 million to $40.2 million.
Despite national concerns about the clinical value and cost of atherectomy procedures driven by limited comparative effectiveness data, the proportion of infrainguinal endovascular charges attributable to atherectomy remained relatively stable, ranging from 60.1% to 67% of total charges across years.
The concentration of spending in endovascular procedures was striking. The highest-paid non-endovascular procedure ranked no higher than seventh among paid codes in any given year, and no open bypass or groin-level reconstruction procedures appeared among the top 30 paid codes.
"As access to care outside the VA Community Care continues to expand, it is crucial to know which vascular procedures veterans are receiving and how resources are being utilized," said senior author Dr. Gale Tang, Associate Professor of Vascular Surgery at the University of Washington and Section Chief of Vascular Surgery at the VA Puget Sound Health Care System. "These findings underscore the importance of comparative effectiveness research to help physicians make evidence-based treatment decisions."
Future Directions
The investigators plan to examine regional variation in atherectomy and other endovascular procedure rates both within and outside VA Community Care. They also intend to evaluate the number of procedures performed per patient as a measure of care quality and resource stewardship, aiming to improve the quality of care and better inform resource allocation.