Please note that our understanding of the CMS guidelines regarding the determination of the appropriate CPT code for travel is, “The per mile travel allowance is to be used in situations where the average trip to patients’ homes is longer than 20 miles round trip” says “patients’ homes” which is plural, the word “average” suggests the total mileage to be prorated between the total number of patients drawn in a round trip, meaning that the average travel per patient should be longer than 20 miles, in order to qualify for the CPT code P9603.
Moreover, none of the examples of the CPT code P9603 shared by CMS include the scenarios, where the total or average number of miles travelled by a phlebotomist were less than or equal to 20 miles.
For example: “As per the scenarios explained in the attached CMS guidelines, we believe that if a laboratory travels to some patients for specimen collection, the total miles travelled should be divided between the total number of patients and if it turns out to be less than 20 miles per patient, each patient's claim should be billed with the CPT code P9604.”
Also, we had encountered the denials from Medicare HMOs, on the claims initially billed with the CPT code P9603 with less than 21 units, i.e. “HCPCS P9603 should not be billed for mileage (units) less than 21”. Medicaid and most of its HMOs do not even cover P9603 at all.
Looking forward to hear from you all.
Moreover, none of the examples of the CPT code P9603 shared by CMS include the scenarios, where the total or average number of miles travelled by a phlebotomist were less than or equal to 20 miles.
For example: “As per the scenarios explained in the attached CMS guidelines, we believe that if a laboratory travels to some patients for specimen collection, the total miles travelled should be divided between the total number of patients and if it turns out to be less than 20 miles per patient, each patient's claim should be billed with the CPT code P9604.”
Also, we had encountered the denials from Medicare HMOs, on the claims initially billed with the CPT code P9603 with less than 21 units, i.e. “HCPCS P9603 should not be billed for mileage (units) less than 21”. Medicaid and most of its HMOs do not even cover P9603 at all.
Looking forward to hear from you all.