P9603 HCPCS code: Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled
P9603 is the HCPCS Level II code for travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled. In 2024 Medicare paid an average of $1.08 per service for P9603 across 49,488,256 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 100 per day on outpatient hospital claims. Medicare volume rose 21% from 2022 to 2024 (40,962,752 to 49,488,256 services). In 2024, about 430 clinicians billed Medicare for P9603 for 612,853 beneficiaries; Florida, Illinois, Ohio accounted for 48% of services.
Code details
| Field | Value |
|---|---|
| Section | P codes — Pathology and laboratory services |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 22 |
| BETOS category | Y2 |
| Added | 1987-01-01 |
| Last action effective | 1992-01-01 |
Who bills P9603 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 430 |
| Medicare beneficiaries | 612,853 |
| States with claims | 39 |
| Share of services in top 3 states (Florida, Illinois, Ohio) | 48% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for P9603, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 40,962,752 | 549,564 | $1.00 | $1.00 |
| 2023 | 46,288,876 | 585,849 | $1.05 | $1.05 |
| 2024 | 49,488,256 | 612,853 | $1.08 | $1.08 |
States with the most P9603 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 12,770,863 | $1.08 |
| Illinois | 7,423,845 | $1.10 |
| Ohio | 3,614,312 | $1.07 |
| California | 3,028,692 | $1.12 |
| New Jersey | 2,889,276 | $1.10 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 100 | Clinical: Data |
| practitioner claims | 300 | Clinical: Data |
What changed for P9603
- 1987-01-01: P9603 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code P9603?
P9603 is the HCPCS Level II code for travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled. Short descriptor: "One-way allow prorated miles".
How much does Medicare pay for P9603?
In 2024, the average Medicare payment was $1.08 per service (average allowed $1.08).
Does Medicare cover P9603?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of P9603 can be billed per day?
100 on outpatient hospital claims; 300 on practitioner claims (NCCI medically unlikely edits).
Related P96 codes
- P9604 — Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge
- P9612 — Catheterization for collection of specimen, single patient, all places of service
- P9615 — Catheterization for collection of specimen(s) (multiple patients)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under P9603
- Watch P9603 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for P9603
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.