Blue Cross Blue Shield Michigan travel lodging Coverage

Coverage Criteria for Travel and Lodging

Eligibility for travel and lodging benefit

Covered when ALL of the following are met

eligibility: 1) Member is enrolled in a Medicare Plus Blue Group PPO plan that purchased the enhanced travel and lodging benefit; 2) The service is associated with a Medicare-covered organ transplant or a Medicare-approved clinical trial; 3) For solid organ transplants, the surgery is performed at a facility that has a Medicare provider agreement and is certified by CMS for the relevant covered procedure; 4) Travel distance from the member's residential address on record to the transplant or clinical trial facility is at least 100 miles one way; 5) Travel and lodging expenses are reasonable and necessary and supported by required legible receipts, itineraries, and documentation as specified by the plan (member name, contract and group number, residential address, facility and lodging addresses, itemized statements and paid receipts).

This enhanced benefit applies only to select Medicare Plus Blue Group PPO groups that purchase it; individual Medicare Plus Blue PPO members are excluded and groups may modify limits via their Summary of Benefits or Evidence of Coverage.

Reimbursement maximums and rules

Payment limits and duration

limits: 1) Combined daily allowance payable up to $150 per day unless the group specifies a different combined maximum; 2) Travel reimbursed (car, bus, air, rental) up to $300 per person per trip with legible receipts and itineraries; 3) Land travel limited to a maximum total of four days to and from the Medicare-approved transplant or clinical trial facility; 4) Mileage for personal vehicle use reimbursed using the IRS mileage rate in effect at the time of service and calculated from the member's residential address of record to the approved facility; when rental vehicles are used, rental fees and gasoline are covered but mileage is not; 5) Maximum total payable: $10,000 for all travel and lodging related to an initial solid organ transplant; $5,000 for all travel and lodging related to an approved clinical trial or bone marrow transplant; currency exchange rules apply when required.

Groups may set different combined maximums in their Summary of Benefits or Evidence of Coverage; mileage for daily travel is calculated between approved facility and lodging facility for daily allowances.

Items that are not directly related to travel and lodging expenses are excluded from reimbursement. Examples include alcoholic beverages, car maintenance, clothing, dry cleaning, entertainment (such as cable television, books, magazines, movie rentals), flowers, household products, household utilities (including cell phone charges, maid, babysitting or day care services), kennel fees, laundry services, meals for the patient and accompanying persons (except inpatient hospital meals, which are covered as part of inpatient care), security deposits, toiletries, and toys.

The travel and lodging benefit is available only when it is associated with a Medicare-covered organ transplant or a Medicare-approved clinical trial and when other facility requirements are met. Specifically, reimbursement requires the service to be for an organ transplant or clinical trial covered by the group's plan; for solid organ transplants the surgery must be performed at a facility that has a Medicare provider agreement and CMS certification. Original Medicare only covers travel and lodging for Medicare-approved organ transplants when the Medicare Advantage plan chooses to provide services at a Medicare-approved transplant facility at a distant location.

Coding and Distance Rules

HCPCS codes eligible for paymentHCPCSCovered

A0090
A0100
A0110
A0140
A0170
A0180
A0200

HCPCS codes eligible for payment (duplicate source listing)mixedCovered

A0090
A0100
A0110
A0140
A0170
A0180
A0200

Minimum distance for eligibility

Minimum one-way distance>= 100 miles from member's residential address to the transplant facility or clinical trial location

Applies toMembers of Medicare Plus Blue Group PPO plans that purchased the enhanced travel and lodging benefit (not individual Medicare Plus Blue PPO members)

Address of recordDistance calculated from the member's residential address on record (P.O. boxes not acceptable)

Provider and Member Actions / Documentation

Prior Authorization

Coverage condition — enhanced benefit and Original Medicare alignment

Travel and lodging is provided as an enhanced coverage option for Medicare Plus Blue Group PPO plans and is available only for groups that purchase the enhanced benefit. Coverage and reimbursement methodology, maximum payment amounts, member cost sharing, and eligible services are determined by the group’s benefit design and the group's Summary of Benefits or Evidence of Coverage. Travel and lodging reimbursement requires a minimum of 100 miles traveled one way from the member's residential address on record to the transplant facility or clinical trial location. When purchased, travel and lodging benefits are available for all transplants and for Medicare-approved clinical trials covered by the group's benefit plan. The travel and lodging benefit period for a covered organ transplant begins five days prior to the initial transplant and extends through the patient's transplant episode of care not to exceed one year after surgery. 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. For Medicare-approved clinical trials, travel and lodging benefits begin with the first service date of the clinical trial and end 180 days after that date.

Applies only when the group has purchased the enhanced travel and lodging benefit
Minimum 100-mile one-way travel requirement for reimbursement
Transplant benefit period: 5 days prior through transplant episode of care, up to 1 year post-surgery
Clinical trial benefit period: first service date through 180 days

Transplant- and Trial-specific Rules

Transplant- and trial-specific rules

Applies to transplants when the group's enhanced benefit is purchased

solid_organ_episode: Solid organ transplant travel and lodging benefits begin five days prior to the initial transplant and extend through the transplant episode of care not to exceed one year after surgery; surgeries must be at facilities with a Medicare provider agreement and CMS certification.

Maximum total payable for initial solid organ transplant travel and lodging is $10,000.

bone_marrow_and_clinical_trials: Travel and lodging benefits for Medicare-approved clinical trials and bone marrow transplants begin with the first service date of the clinical trial and end 180 days after that date; maximum total payable is $5,000.

Land travel limited to four days to/from facility; combined daily allowance and per-trip travel limits apply as specified by group policy.

Verification and Evaluation Requirements

Prior Authorization

Verify Medicare coverage with group's administrator

Before authorizing travel and lodging reimbursement, verify that the transplant is Medicare-covered or that the clinical trial is Medicare-approved with the group's Supervisor/Administrator and confirm the member's group has purchased the enhanced benefit.

Confirm the group purchased the enhanced travel and lodging coverage and review the group's Summary of Benefits or Evidence of Coverage for plan-specific limits.
Verify minimum distance requirement (100 miles one way) and facility certification as applicable.

Facility and Center Requirements

Documentation Required

Facility must have Medicare agreement and CMS certification

Ensure solid organ transplant surgeries are performed at facilities that have a Medicare provider agreement and are certified by CMS for the relevant transplant program; travel and lodging benefits for solid organ transplants apply only when this facility requirement is met.

Facility must have a Medicare provider agreement and CMS certification for the relevant covered procedure.
Benefits for solid organ transplants begin five days prior to transplant and extend through the transplant episode of care up to one year after surgery, when performed at an approved facility.

Post-Transplant Travel and Lodging

Travel and lodging reimbursement

Daily combined allowanceBenefits payable up to a combined maximum of $150 per day unless the group specifies a different amount

Per-person travel capTravel reimbursed up to $300 per person per trip with legible receipts and itineraries

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

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

Mileage and rental rulesIRS mileage rates used for personal vehicle reimbursement; rental fees and gasoline covered when rental used (mileage not reimbursed)

Background

Medicare Plus Blue Group PPO offers travel and lodging as an enhanced benefit for select employer or group plans that purchase this option. The benefit supplements Original Medicare and is available to members of those groups (it does not apply to Medicare Plus Blue PPO individual members). Coverage scope, reimbursement methodology, maximums and any member cost sharing are determined by the purchasing group; members should consult their group's Summary of Benefits or Evidence of Coverage for plan-specific details. When purchased, the benefit applies to covered transplants and Medicare-approved clinical trials and begins five days prior to the initial transplant extending through the transplant episode of care (not to exceed one year), or beginning with the first clinical trial service and ending 180 days after that date.

Definitions

Transplant episode of care

Episode startBegins five days prior to the initial transplant

Episode end (solid organ)Extends through the transplant episode of care not to exceed one year after surgery

Clinical trial durationFor Medicare-approved clinical trials, benefits begin with the first service date and end 180 days after that date

Facility requirementSolid organ transplant surgeries must be performed at a facility with a Medicare provider agreement and CMS certification

OpenPayer

Travel and lodging for Medicare Advantage transplant and clinical trial services