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Help! Billing for travel expenses?

  1. Default Help! Billing for travel expenses?
    Medical Coding Books

    I work at Lab and we send our Phlebotomists to Assisted Living & Nursing homes a few times a week. We are looking into billing to Medicare for the trip the Phlebotomist has to take to the patients and back to the lab. Has anyone billed the HCPCS code P9603 before to Medicare? is this the correct code? Are there any modifiers, etc.? Any help would be greatly appreciated. Thanks

  2. Default Travel Charges for Outreach Specimens

    I am a Pre-Bill Data Integrity Specialist-Lab focused. The billing for travel charges was implemented here at our facility a very long time ago- the basics are listed below and there is also information from MLN Matters- you can also look at CMS website for information.

    Medicare will reimburse for travel charges for patients who are homebound or nursing home patients.
    In order to capture revenue for HCPCs code P9604 documentation must be provided for the patients who meet the criteria for the charges and are within 20 miles or less round trip.
    Documentation will include:
    ? Date of Service
    ? Patient Name
    ? Patient Location
    ? Patient Insurance
    ? Vehicle Used
    ? Beginning/Ending mileage
    ? Technician

    The calculation for charges will be based on the Medicare flat rate travel allowance of $10.15. This flat rate will be pro-rated for multiple patients visited on the same trip and/or nursing home patients.

    6-total patients
    5-patients are Medicare recipients and meet medical necessity for homebound patients.
    Trip= Leaving and returning.
    Calculation = 2 x $10.15 = $20.30
    $20.30 / 6 = $3.38
    Charge will be $3.38 for each Medicare patient.

    Travel codes allow for payment either on a per mileage basis (P9603) or on a flat rate per trip basis
    (P9604). Payment of the travel allowance is made only if a specimen collection fee is also payable. The
    travel allowance is intended to cover the estimated travel costs of collecting a specimen including the
    laboratory technician?s salary and travel expenses. Medicare contractor discretion allows Medicare
    contractors to choose either a mileage basis or a flat rate, and how to set each type of allowance.
    Because of audit evidence that some laboratories abused the per mileage fee basis by claiming travel
    mileage in excess of the minimum distance necessary for a laboratory technician to travel for specimen
    collection, many Medicare contractors established local policy to pay on a flat rate basis only.
    Under either method, when one trip is made for multiple specimen collections (e.g., at a nursing home),
    the travel payment component is prorated based on the number of specimens collected on that trip, for
    both Medicare and non-Medicare patients, either at the time the claim is submitted by the laboratory or
    when the flat rate is set by the contractor.
    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 under Section 1833(h)(3) of the Act. Payment for these services is made based on
    the clinical laboratory fee schedule.

    MLN Matters is a great resource for information.

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