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P9603 and P9604

Apurva Posted Tue 28th of April, 2020 03:53:58 AM
When to bill P9603 & P9604 ? For 88 Miles which CPT needs to be billed P9603 or P9604 and how many units to be billed ? For 12 Miles which CPT needs to be billed P9603 or P9604 and how many units to be billed ?
SuperCoder Answered Wed 29th of April, 2020 04:18:50 AM

Hi Apurva,

Medicare 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.

The travel codes allow for payment either on a per mileage basis (P9603) or on a flat rate per trip basis (P9604).

Per Mile Travel Allowance (P9603): The per mile travel allowance (P9603) is to be used in situations where the average trip to the patients’ homes is longer than 20 miles round trip and is to be prorated in situations where specimens are drawn from non-Medicare patients in the same trip.

The allowance per mile was computed using the Federal mileage rate of $0.575 per mile plus an additional $0.45 per mile to cover the technician’s time and travel costs. Contractors have the option of establishing a higher per mile rate in excess of the minimum $1.03 per mile (actual total of $1.025 rounded up to reflect systems capabilities), if local conditions warrant it.

The minimum mileage rate will be reviewed and updated throughout the year, as well as in conjunction with the CLFS, as needed. At no time will the laboratory be allowed to bill for more miles than are reasonable, or for miles that are not actually traveled by the laboratory technician.

Per Flat-Rate Trip Basis Travel Allowance (P9604) travel allowance is $10.30.

So, in your both the scenarios you can select P9603, because of distance, which is more than 20 moles round trip. Also, allowable units for the code P9603 are 300, so you can select it accordingly.

Hope this helps!

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