(Medicare Claims Processing Manual)

Travel  Allowance  Eligibility   CMS pays a travel allowance when the specimen collection fee is paid.  Requirements regarding payment for  specimen  collection  are described  in Section  60.1 above  and CFR   414.523(a)(1). These requirements must be met for the travel allowance to be payable.   Travel for simple pickup of specimens or for specimen collection that does not require the services of trained  technicians  should not be considered  in the calculation  of the travel  allowance.  This means  that the travel allowance amount may be paid only if a specimen collection fee is also payable; for example, no travel allowance would be paid if a trained technician merely performs a messenger service to pick up a specimen drawn by other technicians.   The travel allowance may be provided only with respect to an individual who is homebound or an inpatient in an inpatient facility (other than a hospital), such that travel allowance may only be paid when a trained technician  draws  a specimen  from  a patient  who either  is in an inpatient  facility  that is not a hospital  or is a homebound patient.  Only  one travel  allowance payment  may be made for specimen  collection  for a Medicare beneficiary  based on the beneficiarys location, and only when a Medicare beneficiary requires the collection of a specimen necessary for performance of CDLTs.   Only  Medicare patients  should be considered  in the calculation  and payment  of the travel  allowance,  as the statutory language states the location of an individual, that is, the location of a Medicare beneficiary receiving  specimen collection  services.  Non-Medicare patients  should not be included in any portion of the calculation of the travel allowance.   Travel  Allowance  Eligible  Miles   For the purposes  of travel  allowance for specimen  collection,  eligible  miles  are those  miles  traveled  that may be included in the calculation to determine the travel allowance amount. Eligible miles begin at the laboratory or the starting point of the trained technicians travel for specimen collection and end at the laboratory or the ending point of the t rained technicians travel for specimen collection.  A trained  technicians  travel  for specimen  collection  from  Medicare beneficiaries  may begin at a laboratory or at a location other than the laboratory. Therefore, eligible miles begin at the laboratory or the starting point of the trained technicians travel for specimen collection.  Additionally, a trained technicians travel for specimen collection from Medicare beneficiaries may end at a laboratory or at a location other than the laboratory.  Therefore, eligible miles end at the laboratory or the ending point of the trained technicians travel for specimen collection.   Eligible miles do not include miles traveled for any purpose unrelated to specimen collection, such as collecting specimens from non -Medicare beneficiaries or for personal reasons. Therefore, any miles traveled to a location where no specimens are collected, such as to the location of a non -Medicare beneficiary  for specimen  collection,  to a Medicare beneficiary  where  no specimen  collection  occurs,  or for personal purposes, are excluded from the calculation of eligible miles.  Effective January 1, 2022, CMS has made permanent the option for laboratories to maintain electronic documentation of miles traveled for the purposes of covering the transportation and personnel expenses for trained technicians to travel to the location of an individual to collect a specimen sample. This option for laboratories to maintain electronic documentation applies to specimen collection for any CDLT. Laboratories may utilize electronic and/or other documentation in order to demonstrate miles traveled for the  purposes  of specimen collection.  Laboratories  need  to be able to produce  electronic documentation in a form and manner that can be shared with MACs and should continue to consult with their local MACs regarding the format and process for submission of this information if necessary.   Travel  Allowance  Mileage Rate   The Act requires  the travel  allowance  to cover  both the transportation  and personnel  expenses for trained personnel to travel to the location of an individual to collect a sample.  The travel allowance mileage rate reflects both of these components.  The transportation  component  of the travel  allowance mileage  rate equals  the IRS standard mileage  rate. The IRS updates and issues standard mileage rates on a periodic basis, generally annually and are used to calculate the deductible costs of operating an automobile for business, charitable, medical, or moving for the purpose of calculating Federal ta xes.  The personnel  expenses component  of the travel  allowance mileage  rate where  the trained  technicians personnel expenses is based on a wages -per-mile amount.  Effective January  1, 2023, CMS  uses wage data in the Bureau  of Labor  Statistics  BLS-defined  category  of phlebotomist to establish the personnel expense component of the travel allowance mileage rate.  Specifically, CMS uses the latest available published figure for the median hourly wage amount for phlebotomists, which  is published by the BLS,  for the purposes  of annually updating the travel  allowance amount for specimen collection.   CMS calculates a per -mile amount to derive the approximate number of miles traveled by the trained technician each hour by using an average driving speed. The average miles -per-hour driving speed is multiplied by the trained technicians estimated wages, as described above, and the result would be an amount  that represents  wages  per mile,  which  is the personnel  expenses  associated  with travel  for specimen collection.  CMS uses an average driving speed of 40 miles per hour, as most of the travel related to specimen collection would be performed in local and residential areas.   To establish the personnel expenses component of the travel allowance mileage rate, which is a per -mile amount,  CMS  divides  the most  recent  median  hourly wage for phlebotomists, as published by the BLS,  by 40, to represent an average miles -per-hour.  The total travel allowance mileage rate, which includes both the transportation and personnel expenses  for trained  personnel  to travel  to the location  of an individual  to collect  a sample,  is equal  to the IRS standard mileage rate plus an amount to cover expenses for a trained technician which is equal to the most recent median hourly wage for phlebotomists, as published by the BLS, divided by 40 to represent an average miles -per-hour driving speed.  Updates  to the Travel  Allowance  Mileage Rate   Updates to the travel allowance mileage rate are issued through subregulatory  guidance, specifically the existing CMS change request process, on an annual basis.  Updates will be made to the travel allowance mileage rate based  upon the  most  recently  published IRS  standard  mileage  rate,  as well as the most  recently published wage rate for phlebotomist as published by the BLS. The revised travel allowance mileage rate will be effective for the January update of the clinical laboratory fee schedule file.   The travel allowance mileage  rate for CY2024 is  $1.13:   The IRS standard  mileage  rate, which  is $0.67;  plus,  The most  recent  median  hourly wage for phlebotomists, as published by the BLS,  which  is $18.53, divided by 40 to represent an average miles -per-hour driving speed, which is $0.46.   Yielding  a total travel  allowance  mileage  rate for CY2024 of $1.133, rounded up to  $1.13.   Travel  Allowance  Bases:  Flat-Rate  and Per-Mile   CMS  pays a travel  allowance on the  following bases:  (1) flat-rate travel  allowance;  and (2) per-mile travel  allowance.   Flat-Rate  Travel  Allowance   The flat-rate travel  allowance basis  applies  when  the trained  technician  travels  20 eligible  miles  or less to and from one location for specimen collection from one or more Medicare beneficiaries.   Laboratories  bill Medicare using HCPCS  code  P9604 to receive payment  for the flat-rate travel  allowance amount, prorated by the number of beneficiaries for whom a specimen collection fee is paid.   Per-Mile  Travel  Allowance   The per-mile travel  allowance basis  applies  in two circumstances:  1) When  the round -trip travel  to one location  is greater  than 20 eligible  miles  for specimen  collection from one or more beneficiaries; or,  2) When  travel  is to more  than  one location, regardless  of the number  of miles  traveled.   Laboratories  bill Medicare using HCPCS  code  P9603 to receive payment  for the per-mile travel  allowance amount, prorated by the number of beneficiaries for whom a specimen collection fee is paid.   Travel Allowance Amount Calculation Calculation: Flat -rate Travel Allowance Basis   For flat-rate travel  allowance  basis,  the travel  allowance  amount  calculation  is the travel  allowance mileage rate multiplied by ten (10)  and divided by the number of beneficiaries for whom a specimen collection fee is paid.   Dividing by the number  of beneficiaries  for whom  a specimen  collection  fee is  paid ensures  that the flat-rate travel allowance amount is apportioned to each beneficiary receiving specimen collection services and that payment is calculated in an operationally feasible manner, as a laboratory must submit a claim for each beneficiary to receive payment for travel allowance.  This method allows for a fixed payment amount to be straightforwardly apportioned to the number  of beneficiaries  for whom  a specimen  collection  fee is paid  in a single location.   Example:  Flat-rate Travel  Allowance  Calculation   For an example of the flat -rate travel allowance calculation, consider a situation in which a trained technician  travels  7 miles  from  the laboratory  to a nursing home  to collect  blood specimens  collected through venipuncture from five patients, four of whom are Medicare beneficiaries.   The trained  technician  collects  three specimens  from  Medicare beneficiaries,  collects  one specimen  from  the non- Medicare patient, and simply picks up a previously collected specimen from one Medicare beneficiary. The trained technician then drives 7 miles back to the laboratory to deliver the specimens without making any other stops.  The trained technician has provided specimen collection services to three Medicare beneficiaries.  One Medicare  beneficiary  did not require  specimen  collection  services,  and therefore,  a specimen  collection  fee would not be payable.   In this example,  the laboratory would use the flat-rate travel  allowance basis  because the trained  technician traveled a total of 14 miles.  To calculate the travel allowance mileage rate, the laboratory would divide flat -rate travel allowance amount of $11.30 by the number of beneficiaries for whom a specimen collection fee is paid (three beneficiaries), which equals $3.77. To bill for the travel allowance, the laboratory would submit one claim for each beneficiary for whom a specimen collection fee is paid by billing HCPCS code P9604.   Calculation:  Per-mile Travel  Allowance  Basis   The calculation  for the per-mile travel  allowance amount  is equal  the number  of eligible  miles  multiplied  by the travel allowance mileage rate, divided by the number of beneficiaries for whom a specimen collection fee is paid.   To calculate the per-mile travel  allowance amount, the laboratory would first calculate the total number  of eligible miles that the trained technician traveled  this would be the total number of miles traveled by the trained technician to locations where one or more Medicare beneficiaries received specimen collection services and back to the laboratory where the technician returns the specimen(s) for testing.  The eligible  miles  would be multiplied  by the travel  allowance mileage  rate as described  above, then divided by the number of beneficiaries for whom a specimen collection fee is paid.  This quotient yields a prorated travel allowance amount for each beneficiary.  The laboratory receives payment for the total number of eligible miles traveled for specimen collection, apportioned equally to each Medicare beneficiary for whom a specimen collection fee is paid.  The laboratory then submits a claim billing HCPCS code P9603 for payment of the per -mile travel allowance amount for each beneficiary for whom a specimen collection fee is paid.  Examples:  Per-mile Travel  Allowance  Amount  Calculation Example 1:  For an example of the per-mile travel  allowance amount  calculation,  consider  a trained  technician  traveling 45 miles  from  a laboratory in a city to a rural SNF,  collecting  blood specimens  through venipuncture  from  6 Medicare beneficiaries, and then driving 45 miles to return to the laboratory.  In this example,  the laboratory would use the per-mile travel  allowance basis  because the trained  technician traveled more than 20 eligible miles to one location for specimen collection.   To calculate the per -mile travel allowance amount, the laboratory would sum the eligible miles traveled to the  location  of Medicare beneficiaries  receiving  specimen  collection  services,  which, in this case is 45 miles from the laboratory to the SNF and 45 miles from the SNF returning to the laboratory, for a total of 90 eligible miles.