Tuesday, September 23, 2008

2008 Correction Payment Fees for Clinical Laboratory Travel Codes P9603 and P9604 for Collection of Specimens

Medicare Part B insurance, will reimburse CLIA's for the services of a specimen collection and travel allowance of a laboratory technician to draw a specimen from either a nursing home patient or homebound patient under Section 1833(h)(3) of the Social Security Act. Payment is made based on the clinical laboratory fee schedule.

The P travel codes allow for payment of the travel allowance 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.

The travel allowance fee schedule is to help cover the estimated travel costs of collecting the specimen, including the laboratory technician’s salary and travel expenses.

The per flat rate trip basis P9604 is $9.55 and should be used for trips under 20 miles round trip. If your distance is longer than 20 miles round trip or you stop to pick up a Non-Medicare specimen in the same trip you will want to use the per mile P9603 $1.035 fee.

On August 1, 2008, the per mile allowance rate of $1.035 cents per mile was computed using the Federal mileage rate of $0.585 cents per mile for automobile expenses plus an additional $0.45 cents per mile to cover the technician’s time and travel costs. Medicare contractors have the option of establishing a higher per mile rate in excess of the minimum of $1.035 cents per mile if local conditions warrant it.

Under either method (i.e., flat or per mile travel allowance), when one trip is made for multiple specimen collections (e.g., at a nursing facility), 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 Medicare contractor.

Medicare Notice: Medicare will not reprocess your claims with the updated Fee Schedule pricing unless you bring it to their attention and ask that they reprocess the claim. It is also recommended to raise your charge fee sctructure for these two procedure codes P9603 and P9604.

Procedure Codes Affected:
P9603 Calendar Year 2008 $1.035 per mile
P9604 Calendar Year 2008 $9.55 per Flat-rate trip

Real Life Billing Scenarios

Example 1: On August 2, 2008, a ARUP laboratory technician travels 60 miles round trip from a lab located in SLC to a Ogden location, and back to the lab to draw a single Medicare patient’s blood. The total reimbursement would be $62.10 (60 miles x 1.035 cents a mile), plus the specimen collection fee.

Example 2: On August 2, 2008, a ARUP laboratory technician travels 40 miles from the SLC 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 SLC lab. The total miles traveled would be 80 miles. The claim submitted would be for one half of the miles traveled or $41.40 (40 x 1.035), plus the specimen collection fee.

Example 3: A ARUP laboratory technician travels from the SLC laboratory to a single Medicare patient’s home and returns to the SLC laboratory without making any other stops. The flat rate would be calculated as follows: 2 x $9.55 for a total trip reimbursement of $19.10, plus the specimen collection fee.

Example 4: A ARUP laboratory technician travels from the SLC laboratory to the homes of five patients to draw blood, four of the patients are Medicare patients and one is not. An additional flat rate would be charged to cover the 5 stops and the return trip to the SLC lab (6 x $9.55 = $57.30). Each of the claims submitted would be for $11.46 ($57.30 /5 = $11.46). Since one of the patients is non-Medicare, four claims would be submitted for $11.46 each, plus the specimen collection fee for each.

Example 5: A ARUP laboratory technician travels from the SLC laboratory to a nursing home and draws blood from 5 patients and returns to the laboratory. Four of the patients are on Medicare and one is not. The $9.55 flat rate is multiplied by two to cover the return trip to the laboratory (2 x $9.55 = $19.10) and then divided by five (1/5 of $19.10 = $3.82). Since one of the patients is non-Medicare, four claims would be submitted for $3.82 each, plus the specimen collection fee.

Note** At no time will a laboratory be allowed to bill for more miles than are reasonable or for miles not actually traveled by the laboratory technician.

To read more about Medicare updates including Health Billing Insurance Information check out Medicare Medical Coding and Billing Courses

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