blue cross blue shield michigan travel lodging Coverage

Enhanced Travel and Lodging Coverage Criteria

Enhanced travel and lodging coverage criteria

Covered when ALL of the following are met:

Enhanced benefit and service coverage: Member is enrolled in a BCN Advantage group plan that has purchased the enhanced travel and lodging benefit and the transplant or clinical trial is covered by the group's benefit plan.

See group Summary of Benefits/Evidence of Coverage for plan-specific variation.

Distance requirement: Member's residential address on record is at least 100 miles one way from the transplant facility or clinical trial location.>=100 miles one-way

Mileage calculated from enrolled member's residential address of record (not a P.O. box).

Covered service type: Service is a Medicare-covered organ transplant at a Medicare-approved facility (facility must have a Medicare provider agreement and CMS certification) or a Medicare-approved clinical trial, or services defined in the Human Organ Transplant Services BCN Advantage enhanced benefit policy paper.

Solid organ transplants must be performed at a facility with a Medicare provider agreement and CMS certification for the procedure.

Timing/benefit period: For transplants: benefits begin five days prior to the initial transplant and extend through the transplant episode of care not to exceed one year after surgery; For Medicare-approved clinical trials: benefits begin with the trial's first service date and end 180 days after that date.<=1 year for transplants; 180 days for trials

Items not directly related to travel and lodging expenses are excluded from reimbursement. Examples include, but are not limited to: alcoholic beverages, car maintenance, clothing, dry cleaning, entertainment (books, magazines, movie rentals, cable), flowers, household products and utilities (including cell phone charges, housekeeper, babysitter or day care services), kennel fees, laundry services, security deposits, toiletries, and toys. Note that meals are excluded except when provided as part of an inpatient hospital stay, which remains covered as inpatient hospital care.

If a member elects to receive a noncovered travel or lodging item or service, the member is responsible for the entire charge. Providers may not require a member to sign an Advanced Beneficiary Notice (ABN) to accept financial responsibility for noncovered travel and lodging items or services. If coverage is uncertain, providers must obtain a coverage determination from Blue Care Network before providing the item or service. If a noncovered item or service is provided without first obtaining a coverage determination, the member must be held harmless for all charges except any applicable cost share. To verify benefits and cost share, providers may use the BCN provider portal or call 1-800-344-8525.

Coding and Distance Requirements

CPT/HCPCS CodesHCPCSCovered

A0090	Nonemergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest.
A0100	Nonemergency transportation; taxi.
A0110	Nonemergency transportation and bus, intra- or interstate carrier.
A0140	Nonemergency transportation and air travel (private or commercial) intra- or interstate.
A0170	Transportation ancillary: parking fees, tolls, other.
A0180	Nonemergency transportation: ancillary: lodging-recipient.
A0200	Nonemergency transportation: ancillary: lodging, escort

ICD-10 CodesICD-10

Not applicable

inv-06: Minimum travel distance — 100 miles one way from member residential address

Minimum one-way distance100 miles one way from member residential address to the transplant facility or clinical trial location

Distance calculation basisMileage calculated from the enrolled member's residential address on record

ApplicabilityApplies only to BCN Advantage group plans that purchased the enhanced travel and lodging benefit (not BCN Advantage individual members)

Provider Requirements, Documentation, and Prior Authorization

Prior Authorization

Benefit verification required

Travel and lodging is an enhanced benefit available only for select BCN Advantage group plans. Providers must verify group-level benefits and member eligibility before scheduling or billing travel and lodging services. Claims may be denied if the group's benefit is not selected or if the member does not meet eligibility criteria (for example, travel less than 100 miles one way from the member's residential address on record to the transplant facility or clinical trial location). Refer to the group's Summary of Benefits or Evidence of Coverage for plan-specific limits and member cost-share details.

Travel and lodging benefit applies only to BCN Advantage groups that purchased the enhanced benefit
Minimum requirement: 100 miles one way from member's residential address on record to facility
Verify group Summary of Benefits / Evidence of Coverage prior to providing services

Prior Authorization

Review policies and prior authorization

Providers and non-contracted providers must review applicable BCBSM reimbursement policies and BCN provider manual rules prior to claim submission. Failure to follow BCBSM/BCN reimbursement policies and Medicare Advantage prior authorization rules may result in claim denials.

Policy Background

Travel and lodging are offered as an enhanced benefit for select BCN Advantage group Medicare Advantage plans when Original Medicare does not cover or limits apply. Coverage is available for members enrolled in groups that purchased this enhanced benefit for Medicare-covered organ transplants or Medicare-approved clinical trials. For transplants, the benefit period begins five days prior to the transplant and continues through the transplant episode of care up to one year after surgery; for Medicare-approved clinical trials the benefit begins on the first trial service date and continues for 180 days. Providers should verify group-level benefit purchase and Medicare coverage status prior to arranging travel and lodging services.

Episode of Care and Benefit Period Definitions

inv-16: Episode of care / benefit period — begins five days prior to the initial transplant and continues through the transplant episode of care up to one year for organ transplants

Transplant benefit periodBegins five days prior to the initial transplant and continues through the transplant episode of care up to one year after surgery

Clinical trial benefit periodBegins with the first clinical trial service date and ends 180 days after that date

Facility requirement for transplantsSolid organ transplants must be performed at a facility with a Medicare provider agreement and CMS certification for the relevant procedure

Transplant Candidate and Timing Criteria

Transplant candidate and timing criteria

Transplant-specific benefit rules

Facility certification: Solid organ transplant surgeries must be performed at a facility that has a Medicare provider agreement and is certified by CMS for the relevant covered procedure.

Pre-transplant timing: Travel and lodging benefit period begins five days prior to the initial transplant.5 days prior

Post-transplant duration: Benefit extends through the patient's transplant episode of care not to exceed one year after surgery.<=1 year

Maximum payable amount for initial solid organ transplant travel and lodging is $10,000 unless the group specifies a different maximum.

Evaluation and Eligibility Verification

Prior Authorization

Verify enrollment and Medicare-approved status

Before providing travel and lodging services, verify that the member is enrolled in a BCN Advantage group that purchased the enhanced benefit and confirm that the transplant or clinical trial is Medicare-covered or Medicare-approved for eligibility.

Transplant Center Requirements

Documentation Required

Confirm facility Medicare agreement and CMS certification

Solid organ transplant surgeries must be performed at a facility with a Medicare provider agreement and CMS certification for the relevant covered procedure; confirm facility eligibility before arranging travel and lodging reimbursements.

Facility must have a Medicare provider agreement
Facility must be certified by CMS for the specific covered procedure

Post-Transplant Travel and Lodging Reimbursement Limits

inv-20: Travel and lodging reimbursement — maximum payable limits: $10,000 for initial solid organ transplant; $5,000 for approved clinical trial or bone marrow transplant

Maximum payable — initial solid organ transplant$10,000 total for all travel and lodging services related to an initial solid organ transplant

Maximum payable — approved clinical trial or bone marrow transplant$5,000 total for all travel and lodging services related to an approved clinical trial or bone marrow transplant (allogeneic or autologous)

Reimbursement basisGroups will reimburse members for covered services based on reasonable charges minus member cost-sharing; currency exchange rate applied when required