Knowledge Base Article
Outpatient FAQ September 2019
NOTE: All in-article links open in a new tab.
Outpatient FAQ September 2019
Tuesday, September 3, 2019
Q:
Our hospital laboratory sometimes sends an employee to a patient’s home or to a nursing home to collect a specimen. What are the Medicare billing requirements for this service?
A:
WPS, the Medicare Administrative Contractor (MAC) for Jurisdictions 5 and 8, recently published an article about Travel Allowance for Phlebotomy and Specimen Collection. Medicare will pay a travel allowance at a per mile rate for distances that are greater than 20 miles (HCPCS code P9603) or at a flat rate for distances of 20 miles or less (HCPCS code P9604). The lab employee must actually collect a specimen by venipuncture or catheterization; Medicare does not reimburse for travel to pick up a pre-collected specimen. For the travel to be covered, the associated laboratory test must be reimbursed. To ensure coverage of the lab test, be sure to have a signed and dated physician’s order or progress note that specifies the test(s) requested, the lab results, a medical diagnosis and relevant signs and symptoms, documentation supporting medical necessity, and documentation that the physician used the lab results in treating the patient.
One of the more stringent requirements for coverage of the travel allowance is that “the patient must be in a nursing facility where there was no qualified staff to collect the specimen or homebound” according to the WPS article. Should a claim for travel allowance be reviewed by a Medicare contractor, there must be documentation supporting one of these requirements. The article provides further details on what makes a patient considered “homebound.”
Another thing to keep in mind is that services must be pro-rated depending on the number of patients for each trip, including both Medicare and non-Medicare patients. For example, if a technician goes to a nursing home and collects from 5 patients, of which 4 are Medicare patients, then the total round-trip miles and/or travel charge would be divided by 5 to determine the mileage or amount that could be billed to each of the four Medicare patients. The WPS article includes specific examples to help providers understand this requirement.
If you have additional questions about the travel allowance, contact your regional MAC.
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.
Yes! Help me improve my Medicare FFS business.
Please, no soliciting.