In a March 14 transmittal to local Medicare contractors, the Centers for Medicare and Medicaid Services (CMS) has set new allowances that clinical laboratories must use for reimbursement of travel to collect specimens from nursing home and homebound beneficiaries. The travel codes allow for payment on either a per-mileage basis (P9603) or on a flat-rate per-trip basis (P9604). The travel allowance is intended to cover the estimated travel costs of collecting a specimen, including the laboratory technician’s salary and travel expenses. Contractor discretion allows the contractor to choose either a mileage basis or a flat rate, and how to set each type of allowance. Because of audit evidence that some laboratories abused the per-mileage fee basis by claiming travel mileage in excess of the minimum distance necessary for a laboratory technician to travel for specimen collection, many contractors established local policy to pay based on a flat-rate basis only. Under either method, when one trip is made for multiple specimen collections (e.g., at a nursing home), the travel payment component is prorated based on the number of specimens collected on that trip, for both Medicare and non-Medicare patients, either at the same time the claim is submitted by the laboratory […]
In a March 14 transmittal to local Medicare contractors, the Centers for Medicare and Medicaid Services (CMS) has set new allowances that clinical laboratories must use for reimbursement of travel to collect specimens from nursing home and homebound beneficiaries.
The travel codes allow for payment on either a per-mileage basis (P9603) or on a flat-rate per-trip basis (P9604). The travel allowance is intended to cover the estimated travel costs of collecting a specimen, including the laboratory technician’s salary and travel expenses. Contractor discretion allows the contractor to choose either a mileage basis or a flat rate, and how to set each type of allowance.
Because of audit evidence that some laboratories abused the per-mileage fee basis by claiming travel mileage in excess of the minimum distance necessary for a laboratory technician to travel for specimen collection, many contractors established local policy to pay based on a flat-rate basis only.
Under either method, when one trip is made for multiple specimen collections (e.g., at a nursing home), the travel payment component is prorated based on the number of specimens collected on that trip, for both Medicare and non-Medicare patients, either at the same time the claim is submitted by the laboratory or when the flat rate is set by the contractor.
Travel code P9603, paid on a per-mile basis where the average trip exceeds 20 miles, is 56 cents per mile, plus an additional 45 cents per mile to cover the technician’s time and travel costs. Contractors have the option of establishing a higher per-mile rate in excess of the minimum $1.01 per mile if local conditions warrant it.
Travel code P9604, paid on a flat-trip basis, is $10.10. The flat-rate travel allowance is to be used in areas where average trips are less than 20 miles round trip. The specimen collection fee will be paid for each patient encounter. This rate is based on an assumption that a trip is an average of 15 minutes and up to 10 miles one way. It uses the federal mileage rate and a laboratory technician’s time of $17.66 an hour, including overhead. While the new rates are effective as of Jan. 1, 2013, the implementation date is June 16, according to CMS Change Request 8641.
