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Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens (LAB)
Posted June 13, 2008
MLN Matters Number: MM5996
Related Change Request (CR) #: 5996
Related CR Release Date: May 30, 2008
Related CR Transmittal #: R1524CP
Effective Date: January 1, 2008
Implementation Date: June 30, 2008
The Clinical Laboratory Fee Schedule Fact Sheet, which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in downloadable format from the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network at www.cms.hhs.gov/MLNProducts/downloads/clinical_lab_fee_schedule_fact_sheet.pdf on the CMS Web site. The Clinical Laboratory Fee Schedule Fact Sheet is also available in print format. To place your order, visit www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS," and select "MLN Product Ordering Page."
Provider Types Affected
Clinical laboratories submitting claims to Medicare contractors (carriers, fiscal intermediaries (FIs), and/or Part A/B Medicare Administrative Contractors (A/B MACs)) for clinical laboratory services provided to Medicare beneficiaries.
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 5996, which clarifies payment of travel allowances, either on a per mileage basis (P9603) or on a flat rate basis (P9604) for calendar year (CY) 2008.
What You Need to Know
Note that Medicare contractors will not reprocess claims that were processed before the new rates were implemented unless you bring such claims to their attention.
What You Need to Do
See the "Background" and "Additional Information" sections of this article for further details regarding these changes.
Background
Part B of Medicare covers 1) a specimen collection fee and 2) a travel allowance for a laboratory technician to draw the specimen from either a nursing home patient or homebound patient, and payment is made based on the clinical laboratory fee schedule. (See §1833(h)(3) of the Social Security Act at www.ssa.gov/OP_Home/ssact/title18/1833.htm on the Internet.) Furthermore, the travel codes allow for payment of the travel allowance either on a per mileage basis (P9603) or on a flat rate per trip basis (P9604), and payment of the travel allowance is made only if a specimen collection fee is also payable.
The travel allowance is intended to cover estimated travel costs of collecting the specimen (including the laboratory technician's salary and travel expenses), and Medicare contractors have the discretion to choose:
- Either a flat rate or a mileage basis, and
- How to set each type of allowance.
The per flat rate trip basis travel allowance (P9604) is $9.55, and the per mile travel allowance (P9603) is $0.955 cents per mile and is used in situations where the average trip to the patients' homes is:
- Longer than 20 miles round trip, and
- To be prorated in situations where specimens are drawn or picked up from non-Medicare patients in the same trip.
The per mile allowance rate of $0.955 cents per mile was computed using the federal mileage rate of $0.505 cents per mile for automobile expenses plus an additional $0.45 cents per mile to cover the technician's time and travel costs. Medicare contractors have the option of establishing a higher per mile rate in excess of the minimum of $0.955 cents per mile if local conditions warrant it.
The standard mileage rate for business is based on a study of the fixed and variable costs of operating an automobile, and the study is conducted on an annual basis for the Internal Revenue Service (IRS). CMS reviews the minimum mileage rate and updates it in conjunction with the clinical laboratory fee schedule as needed.
Under either method (i.e., flat rate allowance or per mile travel allowance), 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 (for both Medicare and non-Medicare patients) either at the time the claim is submitted by the laboratory or when the flat rate is set by the Medicare contractor.
Note: Because of confusion that some laboratories have had regarding the per mile fee basis and the need to 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.
At no time will a laboratory be allowed to bill for more miles than are reasonable or for miles not actually traveled by the laboratory technician.
Additional Information
The official instruction, CR 5996, issued to your carrier, FI, and A/B MAC regarding this change may be viewed at www.cms.hhs.gov/Transmittals/downloads/R1524CP.pdf on the CMS Web site.
If you have any questions, please contact your carrier, FI, or A/B MAC at their toll-free number, which may be found at www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site. For the Upstate Medicare Division (UMD), you can call the toll-free provider line at 877-567-7173.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2007 American Medical Association.
Clinical Laboratory Fee Schedule - Implementation of Section 113 Medicare, Medicaid and State Children's Health Insurance Program (MMSCHIP) Legislation (LAB)
Posted April 24, 2008
MLN Matters Number: MM5987
Related Change Request (CR) #: 5987
Related CR Release Date: April 11, 2008
Related CR Transmittal #: R331OTN
Effective Date: April 1, 2008
Implementation Date: May 12, 2008
The Clinical Laboratory Fee Schedule Fact Sheet, which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in downloadable format from the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network at www.cms.hhs.gov/MLNProducts/downloads/clinical_lab_fee_schedule_fact_sheet.pdf on the CMS Web site.
Provider Types Affected
Clinical laboratories billing Medicare contractors (carriers, fiscal intermediaries, or Part A/B Medicare Administrative Contractors (A/B MACs)) for services to Medicare beneficiaries.
Provider Action Needed
This article is based on Change Request (CR) 5987, which alerts clinical laboratories that, effective for tests furnished on or after April 1, 2008, the Medicare, Medicaid and State Children's Health Insurance Program (MMSCHIP) Extension Act of 2007 sets payment for code 83037 and 83037QW (Hemoglobin; glycosylated (A1c) by device) by crosswalking it to be the same as 83036 (glycosylated (A1c)). Make certain your billing staffs are aware of this change.
Background
The MMSCHIP Extension Act of 2007 passed in December 2007 and included Section 113. Section 113 of the legislation set the price for any diagnostic test for HbA1C that is labeled by the Food and Drug Administration (FDA) for home use equal to the payment rate for a glycated hemoglobin test (identified as of October 1, 2007, by Healthcare Common Procedure Coding System (HCPCS) code 83036 (and any succeeding codes)). The legislation is effective for tests furnished on or after April 1, 2008.
- For calendar year (CY) 2006, the Current Procedural Terminology (CPT) established new code 83037, Hemoglobin; gycosylated (A1C) by device cleared by the FDA for home use. CPT code 83036, glycosylated (A1c), already existed and was priced at $13.56 on the clinical laboratory fee schedule.
- For CY 2006, CMS determined that code 83037 should be paid via carrier gap filling.
- For CY 2007, CMS set the payment for code 83037 by crosswalking it to code 82985 (Glycated protein).
- For tests furnished on or after April 1, 2008, the payment for 83037 or 83037QW will be the same as the payment on the clinical laboratory fee schedule for 83036.
Your Medicare contractor will adjust claims for services on or after April 1, 2008, processed prior to implementation of this change if you bring such claims to the contractor's attention.
Additional Information
To see the official instruction (CR 5987) issued to your Medicare contractor, visit www.cms.hhs.gov/Transmittals/downloads/R331OTN.pdf on the CMS Web site.
If you have questions, please contact your Medicare contractor at their toll-free number, which may be found at www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site. For the Upstate Medicare Division (UMD), you can call the toll-free provider line at 877-567-7173.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2007 American Medical Association. |
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