BILLING NEWS

QW Modifier

Providers possessing a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Wavier or Provider - Performed Microscopy Procedures (PPMP) must utilize a test kit and bill the program utilizing a QW modifier with for the following codes: 80061, 80101, 81003, 81007,82010, 82044, 82055, 82120, 82273, 82274, 82465, 82523, 82570, 82679, 82947, 82950, 82951, 82952, 82985, 83001, 83002, 83036, 83518, 83605, 83718, 83986, 84460, 84478, 84703, 85014, 85018, 85610, 86294, 86308, 86318, 86618, 86701, 87077, 87210, 87449, 87804, and 87880.

Providers who possess a CLIA Certification of Accreditation or CLIA Certificate of Compliance are not required to utilize a test kit when performing the following test: 80061, 80101, 81003, 81007,82010, 82044, 82055, 82120, 82273, 82274, 82465, 82523, 82570, 82679, 82947, 82950, 82951, 82952, 82985, 83001, 83002, 83036, 83518, 83605, 83718, 83986, 84460, 84478, 84703, 85014, 85018, 85610, 86294, 86308, 86318, 86618, 86701, 87077, 87210, 87449, 87804, and 87880. However if a test kit is utilize, the provider must be certified in the appropriate proficiency testing specialty or sub-specialty.

A QW is not required for the following CPT-4 Codes 81002, 81025, 82270, 82962, 83026, 84830, 85013 and 85651 in order for the test to be classified as waived. CPT-4 Code 89300 is identified as a waived test by CMS but it is not a benefit of the Medi-Cal Program.


Published by XIFIN
INDUSTRY NEWS TAGS: CLIA, California Medi-Cal


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