Specimen Collection and Travel Allowance Fees

Specimen Collection Codes

 CPT Codes  Descriptors
36415  Routine Venipuncture  
36600  Withdrawal of arterial blood
93005  Electrocardiogram tracing 

HCPCS Codes  Descriptors
P9612   Catheterize for urine specimen(s)   
P9615  Urine specimen collection, multiple patients  

Specimen Collection Fees and Billing

  • Only one collection fee per day will be allowed for each patient encounter/trip
  • A specimen collection fee is not allowed when the cost of collecting the specimen is minimal, such as a throat culture or a routine capillary puncture for clotting or bleeding time
  • A specimen collection fee is not allowed when the service requiring the collection is not covered due to not being reasonable and necessary or because it is excluded from coverage for other reasons
  • The patient at home usually does stool specimen collection for an occult blood test, and a fee for such collection is not allowed
  • A specimen collection fee may be allowed when it is medically necessary for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient
    • The technician must personally draw the specimen (e.g., venipuncture or urine sample by catheterization)
    • The facility did not have on duty personnel qualified to perform this service
  • When a laboratory obtains the specimen collection in the home place of service (POS 12 or 14) nursing facility (POS 13, 32, 33 or 54) it may receive payment for both the draw and for the associated travel to obtain the specimen(s) for testing

Independent Laboratory 

  • When an independent laboratory obtains a specimen for a homebound or institutionalized patient, the homebound indicator must appear in Loop 2300, CRC/75, 03 for electronic claims. For paper claims, the statement "Homebound" must appear in Item 19 of the CMS-1500 claim form. Claims submitted without this information will be rejected as unprocessable (remark code MA130).
  • A patient will be considered to be homebound if he/she has a condition due to an illness or injury that restricts his/her ability to leave the residence except with the aid of supportive devices (such as crutches, canes, wheelchairs and walkers); the use of special transportation; the assistance of another person; or if leaving home is medically contraindicated

Travel Allowance

  • 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
  • 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
  • Claims for travel allowance submitted with place of service 81/independent lab will be denied
  • The decision is up to the provider which method to use for trips which average more than 20 miles round 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
  • The travel allowance may not be paid to a physician unless the trip to the home or nursing home was solely for the purpose of drawing a specimen. Otherwise, travel costs are considered to be associated with the other purposes of the trip.
  • The allowance is intended to cover the estimated travel costs of collecting a specimen and is an allowance reflecting the technician’s salary and travel costs

 HCPCS Code  Description
 P9603 One-way allow prorated miles 

When/How to Use this Code 

  • Use this code in situations where the average trip to the patient’s home is longer than 20 miles round trip
  • If a specimen is drawn or picked up from a non-Medicare patient, the fee must be prorated
  • The quantity billed for HCPCS code P9603 must reflect the actual number of miles traveled

 HCPCS Code  Description
 P9604 One way allow prorated trip 

When/How to Use this Code

  • Use this code in areas where average trips are less than 20 miles round trip
  • The flat rate travel fee must be prorated when more than one blood draw is performed at the same address and for stops at the homes of Medicare and non-Medicare patients. The claim must be submitted based on the total number of patients seen on that trip.
  • HCPCS code P9604 reflects flat rate, and the quantity billed must be one (0010)

CPT Code Description 
84999  Clinical chemistry test

When/How to Use this Code

  • A payment may be allowed to cover the additional costs of travel to collect a specimen from a nursing home or homebound patient when clinical diagnostic laboratory tests are needed on an emergency basis outside the general business hours of the laboratory making the collection
  • Submit charges for this service with CPT code 84999
  • This code must be submitted with a narrative description of "Emergency, after hours travel allowance" and the information must be submitted in Loop 2300, or 2400, NTE, 02 for electronic claims or as an attachment to the CMS-1500 claim form

HCPCS Modifier LR

  • Laboratories should submit HCPCS modifier LR (informational purposes only) to indicate "Round Trip" on HCPCS code P9604

References:

  • CMS Publication 100-2, Chapter 16, Section 180
  • CMS Publication 100-4, Chapter 16, Section 50.5
  • CMS Publication 100-4, Chapter 16, Section 60