Medicare Pays Less for Specimen Collection in 2011

The price of gas is on the rise but the Medicare travel allowance fees for specimen collection are on the decline. A recurring update notification released Feb. 11 by the Centers for Medicare & Medicaid Services (CMS) revises the per mileage and flat fee travel payment allowances for 2011.

Medicare Part B allows payment for a specimen collection fee and travel allowance, when medically necessary, for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient. Payment for these services is made based on the Clinical Laboratory Fee Schedule (CLFS).

For 2011, payment of travel allowances when billed on a per mileage basis using HCPCS Level II code P9603 Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated miles actually traveled is $0.96 (down 4 cents from last year) and when billed on a flat rate basis using HCPCS Level II code P9604 Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated trip charge is $9.60 (down 40 cents from last year).

It’s up to the Medicare contractor to choose whether to reimburse a lab on either a mileage basis or flat rate, and how to set each type of allowance. Contractors also have the option of establishing a higher per mile rate in excess of the minimum $0.96 per mile if local conditions warrant it. Labs should keep this in mind when negotiating contracts.

Source: CMS Transmittal 2153, Change Request (CR) 7313

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One Response to “Medicare Pays Less for Specimen Collection in 2011”

  1. Iris says:

    Are the lab charges or travel allowance inclusive to the per diem if member is in a Skilled Nursing Facility or do we allow seperate reimbursement under Medicare part B benefits? Also, what place of service is sufficient? I’ve seen labs under 81 and the actual travel under 31

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