Understanding Medicare’s Clinical Laboratory Fee Schedule and Travel Allowance Updates for 2024

As a medical billing and coding company, it’s crucial to stay informed about the latest updates in Medicare policies to ensure accurate billing and reimbursement for healthcare providers. In 2024, several significant changes have been implemented regarding the Clinical Laboratory Fee Schedule (CLFS) and travel allowance fees for specimen collection services for Medicare patients. Let’s delve into these updates to better equip providers and billing staff with the necessary information.

Clinical Laboratory Fee Schedule Updates

Medicare Part B reimburses specimen collection fees and travel allowances for laboratory technicians when medically necessary, in accordance with Section 1833(h)(3) of the Social Security Act. The fees are determined based on the CLFS, and for 2024, notable changes have been made:

1. Increase in Specimen Collection Fee: The general specimen collection fee has been raised from $8.57 to $8.83. Additionally, a $2.00 increase is applied for specimens collected from Medicare patients in skilled nursing facilities (SNFs) or on behalf of home health agencies (HHAs), resulting in a $10.83 fee for these patients.
2. Eligibility Criteria for Specimen Collection Fee: To qualify for a specimen collection fee, the specimen must be used for a clinical diagnostic laboratory test (CDLT) paid under CLFS regulations. It should be collected by a trained technician from a Medicare patient who is homebound or a nonhospital inpatient, provided there are no qualified personnel available at the facility to collect the specimen. Eligible specimens include blood samples through venipuncture or urine samples collected by catheterization.
3. HCPCS Codes for Specimen Collection: Specimen collection services are identified by specific HCPCS codes, including 36415, G0471, P9612, and P9615, depending on the type and location of specimen collection.

Travel Allowance Policy Updates

Medicare also provides a travel allowance when reimbursing specimen collection fees. Here are the key updates regarding travel allowance:

1. Eligible Miles: Travel allowance covers eligible miles from the laboratory or starting point of the technician’s travel to the location of specimen collection and back. It excludes miles traveled for unrelated purposes or non-Medicare patients.
2. Documentation of Miles: Laboratories have the option to maintain electronic documentation of miles traveled, which applies to specimen collection for any CDLT. This documentation must be shareable with Medicare Administrative Contractors (MACs).
3. Mileage Rate: The travel allowance mileage rate for 2024 is $1.13, comprising the IRS standard mileage rate and personnel expenses based on the wage rate for phlebotomists.
4. Flat-Rate and Per-Mile Basis: Travel allowance can be provided on a flat-rate basis for trips of 20 eligible miles or less, or on a per-mile basis for longer trips or multiple locations. HCPCS codes P9604 and P9603 are used for billing, respectively.

Conclusion

These updates aim to ensure fair reimbursement for laboratory services while maintaining efficiency and accuracy in Medicare billing. It’s imperative for providers and billing staff to familiarize themselves with these changes to optimize reimbursement and compliance with Medicare regulations. For more detailed information and guidance, providers are encouraged to consult the official instruction issued to MACs (CR 13503) and reach out to their MACs for further assistance.