The travel allowance is intended to cover the estimated travel costs of collecting a specimen and to reflect the technician’s salary and travel costs. Travel allowance may be made in addition to a medically necessary specimen collection fee when the specimen is collected from a nursing home or homebound patient.
Used in situations where the average trip to patients’ homes is longer than 20 miles round trip.
For services rendered in calendar year (CY) 2022 the travel allowance is $1.04 per mile:
Is to be pro-rated in situations where specimens are drawn or picked up from non-Medicare patients in the same trip.
No allowance will be made when a technician is acting as a messenger service to pick-up a specimen drawn by a physician or nursing home personnel.
No allowance will be made if the technician arrives for pick-up and no specimen is retrieved (i.e., patient refusal of collection).
May not be paid to a physician unless the trip to the home or nursing home was solely for the purpose of drawing/collecting a specimen:
Travel costs are not separately reimbursable if services are rendered for patient care at the time of the drawing/collection of a specimen.
Example 1: In CY 2022, a laboratory technician travels 60 miles round trip from a lab in a city to a remote rural location, and back to the lab to draw a single Medicare patient’s blood.
The total reimbursement would be $62.40 (60 miles x $1.04 a mile), plus the specimen collection fee.
Example 2: In CY 2022, a laboratory technician travels 40 miles from the lab to a Medicare patient’s home to draw blood, and then travels an additional 10 miles to a non-Medicare patient’s home and then travels 30 miles to return to the lab.
The total miles traveled would be 80 miles.
Claim submitted would be for one-half of the miles traveled or $41.60 (40 miles x $1.04 a mile), plus the specimen collection fee:
Second collection was for a non-Medicare patient.
Used in situations where average trips are less than 20 miles round trip.
For services rendered in CY 2022, one-way flat rate travel allowance has a minimum reimbursement of $10.40:
Annual updates are listed in CMS IOM Pub. 100-04, Medicare Claims Processing Manual Chapter 16,
One unit is billed per stop:
If a single trip is done to and from a Medicare patient's home the units are calculated and billed as two (2).
Specimen collection fee will be paid for each patient encounter.
Flat rate travel fee is to be pro-rated for more than one blood drawn at the same address, and for stops at the homes of Medicare and non-Medicare patients:
Laboratory does the pro-ration when the claim is submitted based on the number of patients seen on that trip.
Example 1: A laboratory technician travels from the laboratory to a single Medicare patient’s home and returns to the laboratory without making any other stops (total round-trip mileage is 8 miles).
The flat rate would be calculated as follows:
2 x $10.40 for a total trip reimbursement of $20.80, plus the specimen collection fee.
Example 2: A laboratory technician travels from the laboratory to the homes of five patients to draw blood, four of the patients are Medicare patients and one is not.
An additional flat rate would be charged to cover the 5 stops and the return trip to the lab (6 x $10.40 = $62.40).
Each of the claims submitted would be for $12.48 ($62.40/5 = $12.48):
Since one of the patients is non-Medicare, four claims would be submitted for $12.48 each, plus the specimen collection fee for each.
Independent laboratories must submit HCPCS code P9603 (per mile) or P9604 (flat rate) for each patient encounter for places of service:
12 - home
13 - assisted living facility
14 - group home
31 - nursing facility
32 - domiciliary care
33 - custodial care
54 - intermediate care facility
Note: Claims will be denied for travel allowance submitted with place of service 81 - independent lab.
Laboratories should submit HCPCS modifier LR (informational purposes only) to indicate "round trip" when using HCPCs code P9604 (Travel allowance, prorated trip charge).
Be sure to include:
All available documentation that supports medical necessity of services.
Travel log supporting miles billed and how many specimens were received/collected.
Verification of miles billed with online mapping programs (i.e., Google Maps, MapQuest, etc.):
Include the address of specimen pickup.
If you determine that incorrect information was submitted on your claim or your claim was billed in error, please use one of the following to update your claim:
Claim correction
Billed in error
Clerical error reopening
Claim correction
Claim correction
Billed in error
Billed in error
Please review our Submit Claim Corrections & Reopenings (JH) (JL) section in our Appeals Center for further direction on the best option to correct/update your claim.
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