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Medicare Travel Allowance Fees for Specimen Collection

June 24, 2008:
For calendar year 2008, Medicare Part B will provide benefits for a specimen collection fee as well as a travel allowance for a laboratory technician to draw a specimen from a nursing home patient or homebound patient, with payment based on the clinical laboratory fee schedule.

The Centers for Medicare and Medicaid Services (CMS) announced the allowance in May, with an effective date of January 1, 2008. The travel codes allow for payment either on a per mileage basis (P9603) or on a flat rate per trip basis (P9604). Payment of the travel allowance is made only if a specimen collection fee is also payable. This allowance is to cover the estimated travel costs of collecting a specimen, including the laboratory technician’s salary and travel expenses.

The choice of a mileage basis or a flat rate is based on the discretion of the contractor since evidence from audits has shown that some laboratories have 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 of the contractors established a local policy to pay based on a flat rate basis only.

CMS will issue a recurring update notification annually for subsequent updated travel allowance amounts.

Per mile travel allowance (P9603): The Centers for Medicare and Medicaid Services will pay a minimum of 95.5 cents per mile travel allowance. The per mile travel allowance is to be used when the average trip to patients’ home is longer than 20 miles round trip. This is to be prorated when specimens are drawn or picked up from non-Medicare patients’ homes in the same trip. The per mile allowance was computed using the federal mileage rate in addition to 45 cents a mile to cover the technician’s time and travel costs. The contractors have the option of establishing a higher per mile rate in excess of the minimum 95.5 cents a mile in the current year 2008, but that is only if local conditions warrant it. Please note, this rate is based on an assumption that a trip is an average of 15 minutes and up to 10 miles one way.

Flat rate (P9604): CMS will pay a minimum of $9.55 one-way, flat-rate travel allowance. The flat-rate travel allowance is to be used when the average trip is less than 20 miles round trip. The flat-rate travel fee will be prorated for more than one blood draw and for stops for Medicare and non-Medicare patients at the same residence. The laboratory does the prorating upon submission of the claim based on the number of patients seen on that trip. The specimen collection fee will be paid for each patient encounter.

Janice Randall-Payne, B.S., CPC, CPC-H, CPC-I, CCS-P, CPAR, PCS
Clinical/Technical Editor


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