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
P9604 is a 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. It belongs to the Pathology and Laboratory Services section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of P9604 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 2 units MAI 3 — Date of Service Edit: Clinical · Clinical: Data
- outpatient
- 2 units MAI 3 — Date of Service Edit: Clinical · Clinical: Data
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for P9604
- Long descriptor
- 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
- Added
- January 1, 1987
- BETOS
- Y2
- Pricing indicator
- 22 — Clinical lab fee schedule
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Price established by carriers — gap-fills or carrier-established panels.
Codes adjacent to P9604
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If P9604 is not quite right, the correct code is very often within a few positions of it.
- P9060Fresh frozen plasma, donor retested, each unit
- P9070Plasma, pooled multiple donor, pathogen reduced, frozen, each unit
- P9071Plasma (single donor), pathogen reduced, frozen, each unit
- P9072Platelets, pheresis, pathogen reduced or rapid bacterial tested, each unitterminated
- P9073Platelets, pheresis, pathogen-reduced, each unit
- P9099Blood component or product not otherwise classified
- P9100Pathogen(s) test for platelets
- P9603Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled
- P9612Catheterization for collection of specimen, single patient, all places of service
- P9615Catheterization for collection of specimen(s) (multiple patients)
- Q0035Cardiokymography
- Q0081Infusion therapy, using other than chemotherapeutic drugs, per visit
- Q0083Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit
- Q0084Chemotherapy administration by infusion technique only, per visit
- Q0085Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit
- Q0091Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory
Questions about P9604
What is HCPCS code P9604?
P9604 is a 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. It sits in the Pathology and Laboratory Services section.
Does Medicare cover P9604?
The CMS HCPCS file marks P9604 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is P9604 paid under the physician fee schedule?
P9604 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.