Effective Feb. 7, the Centers for Medicare & Medicaid Services (CMS) has implemented updates to its specimen collection fees and travel allowances for laboratories under the Clinical Laboratory Fee Schedule (CLFS).
Medicare Part B pays a specimen collection fee and travel allowance when a laboratory technician must draw a specimen from a homebound or nursing home patient. For calendar year 2024, the general fee for specimen collection has increased from $8.57 to $8.83 according to the Consumer Price Index for all Urban Consumers. Additionally, this general fee has increased to $10.83 for specimens collected from a Medicare patient in a skilled nursing facility or by a laboratory on behalf of a home health agency. Only one specimen fee will be paid per patient encounter, regardless of the number of different specimens collected.
CMS also clarified eligibility requirements for the specimen collection fee. The specimen must be:
- Used to perform a clinical diagnostic laboratory test paid under the CLFS regulations at 42 CFR 414.523
- Collected by a trained technician from a Medicare patient who is homebound or is a nonhospital inpatient, only when there are no qualified personnel available at the facility to collect the specimen
- Collected as a blood specimen through venipuncture or a urine sample collected by catheterization
A travel allowance is paid only when the specimen being collected is eligible for the collection fee. Only Medicare patients are included in calculations of travel allowance. The travel allowance mileage rate for CY 2024 is $1.13, based on the Internal Revenue Service standard mileage rate ($0.67) and the median Bureau of Labor Statistics published hourly wage ($18.53) divided by 40 to represent an average miles-per-hour driving speed ($0.46).
CMS will pay a travel allowance either as a flat-rate or a per-mile travel allowance. The flat-rate travel allowance is $11.30 and applies when a trained technician travels 20 miles or less to and from a single location for specimen collection from at least one Medicare patient. Laboratories bill Medicare using the HCPCS code P9604 to obtain the flat-rate travel allowance, prorated by the number of patients for whom a specimen collection fee is paid.
The per-mile travel allowance applies either when the trained technician travels more than 20 miles to and from a single location or if the trained technician travels to more than one location regardless of mileage. Laboratories bill Medicare using the HCPCS code P9603 to obtain the per-mile travel allowance, prorated by the number of patients for whom a specimen collection fee is paid.
Any travel allowances already paid for a date of service on or after Jan. 1, 2024, will be adjusted according to the updated payment rates within the CLFS.
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