HCPCS P9603 & HCPCS P9604 | Descriptions & Billing Guide
HCPCS code P9603 and HCPCS code P9604 can be used for traveling to collect specimens. Below we explain the difference between these codes.
1. General Billing Guidelines
CMS permits a travel allowance when providers must go to a homebound patient to collect a medically necessary specimen. There are several guidelines for the payment of this allowance.
A provider must also be able to bill for a specimen collection service, and both codes must appear on the same claim. In addition, the provider must draw the specimen personally and not just pick up and deliver a specimen that another provider collects.
The allowance is not payable to a physician unless the visit is solely for specimen collection. The travel allowance includes travel costs, the provider’s salary, and travel expenses for round trips up to twenty miles.
2. What Is HCPCS Code P9603?
HCPCS P9603 covers the traveling of collected specimens by a provider to a homebound or nursing home-bound patient. The collection of the specimen must be medically necessary.
A set payment rate times the actual miles traveled one way determines the total amount of the allowance.
2.1 Description
HCPCS describes P9603 in the manual as: “Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually traveled.”
2.2 Code Explanation
The provider goes to a homebound or nursing home-bound patient to collect a medically necessary specimen. The collection is separately reportable.
A set payment rate times the number of actual miles the provider travels determines the allowance for this service. For example, the set payment rate of X cents per mile times the number of miles a provider travels one way determines the total amount of the allowance.
2.3 Billing Guidelines
The travel allowance includes travel costs, the provider’s salary, and travel expenses. When a provider takes more than one specimen at the same location, he must prorate or equally distribute the charges he bills among the total number of specimens.
3. What Is HCPCS Code P9604?
HCPCS P9604 also covers a provider’s travel to collect specimens. This code can be used for homebound patients or nursing home-bound patients.
The collection of the specimen must be medically necessary. The provider may bill a set fee per round trip. If a provider takes more than one specimen per round trip, he must prorate or equally distribute the round trip fee among the number of specimens.
3.1 Description
The P9604 code is described by HCPCS as follows: “Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge.”
3.2 Code Explanation
The provider goes to a homebound or nursing home-bound patient to collect a medically necessary specimen. The collection is separately reportable.
3.3 Billing Guidelines
The travel allowance includes travel costs, the provider’s salary, and travel expenses. When a provider takes more than one specimen at the same location, he must prorate or equally distribute the charges he bills among the total number of specimens.
4. Resources
HCFA Common Procedure Coding System (HCPCS).: (non-CPT-4 portion).
https://www.mass.gov/doc/114-3-20doc/download
Buck’s 2020 HCPCS Level II E-Book
