Laboratory Question for the Week of April 4, 2022

Question:

As a follow-up question to last week’s topic, can you provide any examples of per flat-rate trip billing?

Answer:

CMS gave the following examples for billing and noted that the claimant identifies roundtrip travel by use of the LR modifier: “Example 3: A laboratory technician travels from the laboratory to a single Medicare patient’s home and returns to the laboratory without making any other stops. The flat rate would be calculated as follows: 2 x $10.40 for a total trip reimbursement of $20.80, plus the specimen collection fee. Example 4: A laboratory technician travels from the laboratory to the homes of five patients to draw blood, four of the patients are Medicare patients and one is not. An additional flat rate would be charged to cover the 5 stops and the return trip to the lab (6 x $10.40 = $62.40). Each of the claims submitted would be for $12.48 ($62.40/5 = $12.48). Since one of the patients is non-Medicare, four claims would be submitted for $12.48 each, plus the specimen collection fee for each. Example 5: A laboratory technician travels from a laboratory to a nursing home and draws blood from 5 patients and returns to the laboratory. Four of the patients are on Medicare and one is not. The $10.40 flat rate is multiplied by two to cover the return trip to the laboratory (2 x $10.40 = $20.80) and then divided by five (1/5 of $20.80 = $4.16). Since one of the patients is non-Medicare, four claims would be submitted for $4.16 each, plus the specimen collection fee.”

This question was answered in an edition of our Laboratory Compliance Manager. For more hot topics relating to laboratory services, please visit our store or call us at 1.800.252.1578, ext. 2.