Modifier Coding Alert
Don't Forget Modifier QW with Waived Tests
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Question: How do I get paid for a CLIA-waived test? Medicare is denying the test for being CLIA waived.
Georgia Subscriber
Answer: You need to attach modifier QW (CLIA-waived test) to the procedure code. QW indicates that Clinical Laboratory Improvement Amendments (CLIA) has waived the test and tells the payer that your practice has CLIA-waived status and is allowed to bill for the lab code you’re reporting.
Remember, the code you report must be listed on the fee schedule with the QW modifier.
All laboratories have to be certified by CLIA. Some small in-office labs operate under a “certificate of waiver” and perform only waived tests of low complexity with low risk of error. The list of waived tests that they are allowed to perform is available online at www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/waivetbl.pdf. CLIA establishes three categories of lab tests: waived, moderate complexity, and high complexity.
Some waived complexity tests would include an LDL cholesterol, ethanol (alcohol), or urine qualitative dipstick PH. If a physician in your office performs urine dip sticks (81000-81099, Urinalysis …) and finger sticks for blood glucose (82962, Glucose …) you would attach modifier QW, for example.
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