P9604 HCPCS code: Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge
P9604 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 trip charge. In 2024 Medicare paid an average of $11.13 per service for P9604 across 1,086,793 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 2 per day on outpatient hospital claims. Medicare volume fell 25% from 2022 to 2024 (1,452,864 to 1,086,793 services). In 2024, about 843 clinicians billed Medicare for P9604 for 309,446 beneficiaries; New York, Pennsylvania, California accounted for 47% 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 P9604 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 843 |
| Medicare beneficiaries | 309,446 |
| States with claims | 41 |
| Share of services in top 3 states (New York, Pennsylvania, California) | 47% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for P9604, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,452,864 | 421,354 | $9.92 | $9.92 |
| 2023 | 1,176,975 | 353,724 | $11.32 | $11.32 |
| 2024 | 1,086,793 | 309,446 | $11.13 | $11.13 |
States with the most P9604 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 243,864 | $14.93 |
| Pennsylvania | 135,223 | $6.44 |
| California | 133,187 | $16.19 |
| Oklahoma | 104,114 | $10.84 |
| Florida | 97,989 | $9.85 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Clinical: Data |
| practitioner claims | 2 | Clinical: Data |
What changed for P9604
- 1987-01-01: P9604 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 P9604?
P9604 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 trip charge. Short descriptor: "One-way allow prorated trip".
How much does Medicare pay for P9604?
In 2024, the average Medicare payment was $11.13 per service (average allowed $11.13).
Does Medicare cover P9604?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of P9604 can be billed per day?
2 on outpatient hospital claims; 2 on practitioner claims (NCCI medically unlikely edits).
Related P96 codes
- P9603 — 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
- P9612 — Catheterization for collection of specimen, single patient, all places of service
- P9615 — Catheterization for collection of specimen(s) (multiple patients)
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Next steps
- Run a reimbursement report for a device billed under P9604
- Watch P9604 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for P9604
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.