Outpatient Facility Coding Alert

Published on Thu Jan 22, 2015 PDF

Question: Do we need to append modifier QW to 83009 and 86677 when they are done in the provider facility?

New Jersey Subscriber

Answer: 83009 (Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope [e.g., C-13]) and 86677 (Antibody; Helicobacter pylori) are not included on the Clinical Laboratory Improvement Amendments (CLIA) waved list. The CLIA affects all laboratories and any practice that has an in-office lab however, small. CLIA establishes three categories of lab tests: waived, moderate complexity, and high complexity. Small, in-office labs commonly have a certificate of waiver that allows them to perform and bill only waived tests.

Every CLIA-waived test code is listed twice on the Medicare fee schedule -- once by itself and once with the QW modifier (CLIA-waived test) to indicate the test is CLIA-waived. If your office has a waived lab, you must add modifier QW to every waived lab test you report. This modifier tells Medicare your practice has CLIA-waived status and is allowed to bill for the lab code you are reporting.

However: You can’t just append modifier QW to any lab code and expect to get paid. The code you report must be listed on the fee schedule with QW. You can find a list of CLIA waived tests on the CMS website under “Regulations and Guidance.”