Medicare Compliance & Reimbursement

If the cost of fuel is eating up your reimbursement when your lab technician travels to houses or nursing homes to collect specimens, Medicare has a solution.

CMS Transmittal 1524, effective June 30, reminds practices that Medicare allows reimbursement for "estimated travel costs of collecting the specimen," and Medicare carriers will pay either a flat rate or mileage basis, or can determine a different way to set the allowance, according to MLN Matters article MM5996, which covers this issue.

Per mile: To bill using the per-mile travel allowance, report P9603 (Travel allowance, one way in connection with lab specimen collection), which Part B pays at $0.955 cents per mile.

"You can use this code if you travel longer than 20 miles round trip," said Tina Landskroener, CMBS-I, CCS-P, CPC, office manager with Blessing Physician Services, during the June 25 audioconference, "Critical NCCI Update for Third Quarter 2008."

"Payment using P9603 is prorated if you pick up any non-Medicare specimens along the way," Landskroener says.

Example: Suppose your lab technician travels 60 miles round-trip from the lab in the city to a remote rural location and back to the lab to draw a single Medicare patient's blood.

The total reimbursement would be $57.30, which is the 60 miles times the $0.955 cents per mile, Landskroener says. In addition, you also can charge for the specimen collection fees.

Flat rate: The alternative is to report P9604 (Travel allowance, one way in connection with a lab specimen collection) and collect the flat rate trip payment of $9.55 for each one-way trip.

Important: The lab specimen collection must be the only service that your lab tech is performing if you want to collect the travel allowance, Landskroener says. "If you're taking a blood pressure or doing any other assessments," then you can't bill for the travel.

Round trip: For round trip travel, append modifier LR (Laboratory round trip) to either P9603 or P9604, Landskroener advises.

To read the entire MLN Matters article, go to http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5996.pdf.