In a March 15 transmittal to local Medicare contractors, the Centers for Medicare and Medicaid Services has set the following new allowances that clinical laboratories use for reimbursement of travel to collect specimens from nursing home and homebound beneficiaries. Travel code P9603, paid on a per mile basis where the average trip exceeds 20 miles round trip, is 56.5 cents per mile, plus an additional 45 cents per mile to cover the technician’s time and travel costs, for a total of $1.015 per mile. This total is then rounded up to $1.02 due to processing systems capabilities. Higher rates may be established if local conditions warrant it. Travel code P9604, paid on a flat rate per trip basis, is $10.15. While the new rates are effective as of Jan. 1, 2013, the implementation date is June 17, according to the CMS Change Request 8203. Claims for these services will not be automatically adjusted. Providers must bring any previously paid claims to their contractors’ attention. Travel Allowance Policy Payment of the Part B travel allowance is made only if a specimen collection fee is also payable when it is medically necessary for a laboratory technician to draw a specimen from either […]
In a March 15 transmittal to local Medicare contractors, the Centers for Medicare and Medicaid Services has set the following new allowances that clinical laboratories use for reimbursement of travel to collect specimens from nursing home and homebound beneficiaries.
Travel code P9603, paid on a per mile basis where the average trip exceeds 20 miles round trip, is 56.5 cents per mile, plus an additional 45 cents per mile to cover the technician’s time and travel costs, for a total of $1.015 per mile. This total is then rounded up to $1.02 due to processing systems capabilities. Higher rates may be established if local conditions warrant it.
Travel code P9604, paid on a flat rate per trip basis, is $10.15.
While the new rates are effective as of Jan. 1, 2013, the implementation date is June 17, according to the CMS Change Request 8203. Claims for these services will not be automatically adjusted. Providers must bring any previously paid claims to their contractors’ attention.
Travel Allowance Policy
Payment of the Part B travel allowance is made only if a specimen collection fee is also payable when it is medically necessary for a laboratory technician to draw a specimen from either a nursing home patient or a homebound patient.
Medicare contractors have discretion in choosing to pay either on 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 Medicare contractors established local policy to pay on a flat-rate basis only.
Under either method, when one trip is made for multiple specimen collections (for example, 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 time the claim is submitted by the laboratory or when the flat rate is set by the contractor.
