§414.523. Payment for laboratory specimen collection fee and travel allowance.
42 C.F.R. § 414.523
Specimen collection fee and travel allowance. In addition to the payment amounts provided under this subpart for CDLTs, new CDLTs, and new ADLTs, CMS pays a specimen collection fee, as set forth in paragraph (a)(1) of this section, and a travel allowance, as set forth in paragraph (a)(2) of this section.
Payment for specimen collection. Except as provided in paragraph (a)(1)(v) of this section and subject to the annual update in paragraph (a)(1)(iv) of this section, beginning January 1, 2023, CMS pays $8.57 for all specimens collected in one patient encounter, where the specimen(s) is:
Used to perform a CDLT paid under this subpart G;
Collected by a trained technician from a Medicare beneficiary who is—
Homebound as described in 42 CFR 424.22(a)(1)(ii).
A non-hospital inpatient, but only when no qualified personnel are available at the facility to collect the specimen;
Of the following type—
Blood specimen collected through venipuncture.
A urine sample collected by catheterization.
Beginning January 1, 2024, CMS updates the specimen collection fee amount under paragraph (a)(1) of this section for each calendar year by the percent change in the Consumer Price Index for All Urban Consumers (CPI-U) (U.S. city average) for the 12-month period ending June 30th of the year preceding the update year.
For a specimen collected from a Medicare beneficiary.
Payment for travel allowance—
General requirement. CMS pays a travel allowance, as calculated under paragraph (a)(2)(iii) of this section, where the specimen is one for which a specimen collection fee is paid under paragraph (a)(1) of this section.
Travel allowance basis. CMS pays a travel allowance on the following bases:
Flat-rate travel allowance. The flat-rate travel allowance applies when the trained technician travels 20 eligible miles or less (calculated in accordance with paragraph (a)(2)(iii)(A) of this section) to and from one location for specimen collection from one or more Medicare beneficiaries; or
Per-mile travel allowance. The per-mile travel allowance applies when:
(1) The trained technician travels more than 20 eligible miles (calculated in accordance with paragraph (a)(2)(iii)(A) of this section) to and from one location for specimen collection from one or more Medicare beneficiaries; or
(2) The trained technician travels to more than one location for specimen collection from more than one Medicare beneficiary.
Travel allowance amount—
Eligible miles. Eligible miles begin at the laboratory or the starting point of the technician's travel for specimen collection as specified in paragraph (a)(1) of this section, and end at the laboratory or the ending point of the technician's travel for specimen collection as specified in paragraph (a)(1) of this section. Eligible miles do not include miles traveled for any purpose unrelated to specimen collection as specified in paragraph (a)(1) of this section, such as collecting specimens from non-Medicare beneficiaries or for personal reasons.
Travel allowance mileage rate. The travel allowance mileage rate is equal to the IRS standard mileage rate plus an amount to cover expenses for a trained technician equal to the most recent median hourly wage for phlebotomists, as published by the United States Bureau of Labor Statistics, divided by 40 to represent an average miles-per-hour driving speed.
Travel allowance amount calculation. (1) For the flat-rate travel allowance basis specified in paragraph (a)(2)(ii)(A) of this section, the travel allowance amount is the travel allowance mileage rate specified in paragraph (a)(2)(iii)(B) of this section multiplied by ten, divided by the number of beneficiaries for whom a specimen collection fee is paid under paragraph (a)(1) of this section.
(2) For the per-mile travel allowance basis specified in paragraph (a)(2)(ii)(B) of this section, the travel allowance amount is the number of eligible miles multiplied by the travel allowance mileage rate specified in paragraph (a)(2)(iii)(B) of this section, divided by the number of beneficiaries for whom a specimen collection fee is paid under paragraph (a)(1) of this section.
[Reserved]
Notes, amendments, and revision history
Amendments
[87 FR 70225, Nov. 18, 2022]
Source
Source: 71 FR 69786, Dec. 1, 2006, unless otherwise noted.
Authority
Authority: 42 U.S.C. 1302, 1395hh, and 1395rr(b)(l).
Source
Source: 55 FR 23441, June 8, 1990, unless otherwise noted.
Amendments
[87 FR 70225, Nov. 18, 2022]