The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

Provider Action NeededImpact to YouThis article is based on Change Request (CR) 7239 which revises the payment of travel allowances, eitheron a per mileage basis (P9603) or on a flat rate basis (P9604) for calendar year (CY) 2010.What You Need to KnowNote that Medicare contractors will not re-process claims that were processed before the new rates wereimplemented unless you bring such claims to their attention.What You Need to DoSee the Background and Additional Information Sections of this article for further details regarding thesechanges.BackgroundMedicare, under Part B, covers a specimen collection fee and travel allowance for a laboratory technicianto draw a specimen from either a nursing home patient or homebound patient. Also, the travel codesallow for payment of the travel allowance either on a per mileage basis (P9603) or on a flat rate per tripbasis (P9604), and payment of the travel allowance is made only if a specimen collection fee is alsopayable.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, forboth Medicare and non-Medicare patients, either at the time the claim is submitted by the laboratory orwhen the flat rate is set by the contractor.The per flat rate trip basis travel allowance (P9604) for 2010 is $9.50. The per mile travel allowance (P9603)is $0.95 cents per mile and is used in situations where the average trip to the patients’ home is longer than20 miles round trip, and is to be prorated in situations where specimens are drawn from non-Medicarepatients in the same trip.The allowance per mile was computed using the Federal mileage rate of $0.50 per mile plus an additional$0.45 per mile to cover the technician’s time and travel costs. Medicare contractors have the option ofestablishing a higher per mile rate in excess of the minimum $0.95 per mile if local conditions warrant it.At no time is a laboratory allowed to bill for more miles than are reasonable or for miles that are notactually traveled by the laboratory technician.The Centers for Medicare & Medicaid Services (CMS) reviews the minimum mileage rate and updates itin conjunction with the Clinical Laboratory Fee Schedule (CLFS) as needed.Note: Because of confusion that some laboratories have had regarding the per mile fee basis and the needto claim the minimum distance necessary for a laboratory technician to travel for specimen collection,some Medicare contractors have established local policy to pay based on a flat rate basis only.Additional InformationThe official instruction, CR 7239 issued to your carrier, A/B MAC, or FI regarding this change may beviewed at http://www.cms.gov/Transmittals/downloads/R2110CP.pdf on the CMS Web site.If you have any questions, please contact your carrier, A/B MAC, or FI at their toll-free number, whichmay be found at http://www.cms.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on theCMS Web site.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 65 MMR 2011-01, January 2011