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Fee rates for P9603 and P9604


The allowance per mile was computed using the Federal mileage rate of $ 0.545 per mile plus an additional $ 0.45 per mile to cover the technician’s time and travel costs. MACs have the option of establishing a higher per mile rate in excess of the minimum $ 1.00 per mile if local conditions warrant it. The minimum mileage rate will be reviewed and updated throughout the year, as well as in conjunction with the CLFS, as needed. At no time will the laboratory be allowed to bill for more miles than are reasonable, or for miles that are not actually traveled by the laboratory technician. 

The per flat-rate trip basis travel allowance (P9604) for 2018 is $ 10.00.


Coding Ahead

Examples for P9603


Per Mile Travel Allowance (P9603)

Example 1: In CY 2018, a laboratory technician travels 60 miles round trip from a lab in a city to a remote rural location, and back to the lab to draw a single Medicare patient’s blood. The total reimbursement would be $ 60.00 (60 miles x $ 1.00 a mile), plus the specimen collection fee.

Example 2: In CY 2018, a laboratory technician travels 40 miles from the lab to a Medicare patient’s home to draw blood, and then travels an additional 10 miles to a non-Medicare patient’s home and then travels 30 miles to return to the lab. The total miles traveled would be 80 miles. The claim submitted would be for one half of the miles traveled or $ 40.00 (40 x $ 1.00), plus the specimen collection fee.

Also see P9604


Coding Ahead

Per Mile Travel Allowance P9603


In addition to a specimen collection fee Medicare, under Part B, covers a  travel allowance for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient. The travel allowance is intended to cover the estimated travel costs of collecting a specimen and to reflect the technician’s salary and travel costs.

The travel allowance is not distributed by CMS. Instead, the carrier must calculate the travel allowance for each claim using the following rules for the particular Code. The following HCPCS codes are used for travel allowances:

Per Mile Travel Allowance (P9603)

The minimum “per mile travel allowance” is $ 1.00. The per mile travel allowance is to be used in situations where the average trip to patients’ homes is longer than 20 miles round trip, and is to be pro-rated in situations where specimens are drawn or picked up from non Medicare patients in the same trip. – one way, in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually traveled (carrier allowance on per mile basis);

OR

The per mile allowance was computed using the Federal mileage rate plus an additional 45 cents a 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 ($ 1.00 a mile in CY 2018) if local conditions warrant it. The minimum mileage rate will be reviewed and updated in conjunction with the clinical lab fee schedule as needed. At no time will the laboratory be allowed to bill for more miles than are reasonable or for miles not actually traveled by the laboratory technician.

See Examples..


Coding Ahead