Travel Allowance for Laboratory Services

We have seen an increase in incorrect billing for laboratory service travel allowances. Please see below helpful HCPCS billing information and a link to the CMS IOM on appropriate billing for laboratory services.

P9603 – Per Mile Travel Allowance

• Used in situations where the travel is longer than 20 miles. Providers should bill the actual miles traveled. If the mileage totaled 30 miles one way and it was a round trip, the claim should be billed for a total of 60 miles. Do not append the LR modifier to P9603, even if you are billing for round trip mileage.

P9604 – Flat Rate

• Used in areas where average travel is less than 20 miles round trip. The LR modifier should be appended, which allows the code at 200% for a round trip, along with a quantity bill of one because it is a flat rate reimbursement amount regardless of the number of miles traveled.

For more information, please refer to the CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 16, Section 60.2.

Posted 6/18/2019