HCPCS travel codes allow for payment on either a per mileage basis (HCPCS code P9603) or a flat rate per trip basis (HCPCS code P9604). Payment of the travel allowance is made only if a specimen collection fee is also payable. The travel allowance is intended to cover the estimated travel costs of collecting a specimen including the laboratory technician’s salary and travel expenses. MAC discretion allows the MAC to choose either a mileage basis or a flat rate, and how to set each type of allowance. Many MACs have established local policy to pay based 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 MAC. Per Mile Travel Allowance (P9603)
The per mile travel allowance is to be:
- Used in situations where the average trip to the patients’ homes is longer than 20 miles round trip, and
- Prorated in situations where specimens are drawn from non-Medicare patients in the same trip.
The Internal Revenue Service determines the standard mileage rate for businesses based on periodic studies of the fixed and variable costs of operating an automobile. The allowance per mile was computed using the Federal mileage rate of $0.56 per mile plus an additional $0.45 per mile to cover the technician’s time and travel costs.
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.
Per Flat-Rate Trip Basis Travel Allowance (P9604)
The per flat-rate trip basis travel allowance is $10.10
For more information please visit http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8641.pdf