Wiki HCPCs code P9604 Flat Rate travel allowance for Phlebotomist

[suki_26]

We have just learned about this HCPCs code P9604. We are PCPs with a traveling phlebotomist and our own lab. this code should allow us to bill for travel when she gets blood specimens from our house call patients. Has anyone used this code? We have looked all over even contacting our Medicare MAC (NGS) to get clarification as to how to bill this code. We were told they will investigate it and someone will get back to me in 45 days. We can not find anything that gives clear parameters about the flat rate portion.
Is it saying if the phlebotomist travels more than 20 miles in a session that we have to bill per mile?
Any help on this would be greatly appreciated.

 

[brucep]

According to Chapter 16 of the Medicare Claims Processing Manual, you should bill P9603 “when the round-trip travel to one location is greater than 20 eligible miles for specimen collection from one or more beneficiaries,” or “when travel is to more than one location, regardless of the number of miles traveled.” P9604 is for 20 miles or less. The amount billed for P9603 is the current travel allowance rate ($1.20) x miles divided by the number of beneficiaries from whom the phlebotomist has collected specimens. You should bill the amount for each beneficiary on separate claim lines.

Hope that helps.