Question 1

What is HCPCS code P9604?

Accepted Answer

HCPCS code P9604 is "One-way allow prorated trip". Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge

Question 2

What category is P9604 in?

Accepted Answer

P9604 belongs to HCPCS Category P (Pathology and Laboratory).

Question 3

When should I use HCPCS code P9604?

Accepted Answer

Use P9604 when billing for one-way allow prorated trip. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is P9604 covered by Medicare?

Accepted Answer

Coverage for P9604 (One-way allow prorated trip) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for P9604?

Accepted Answer

Documentation for P9604 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).