Wiki 80305 Denials

[BillingAMC]

Hi All, anyone have feedback around being denied for 80305 even when using the QW modifier for medically necessary. Anyone addressed this issue and what are some common DX used properly with this code? Thank you!!

 

[CodingKing]

QW is not related to medical necessity. It just means its a CLIA waived test.

It may depend on the payer what is covered. Seems many like to follow CMS.

For example here is an LCD from one of the CMS MAC's

https://www.cms.gov/medicare-covera...&DocType=Active|Future&s=All&bc=AggAAAQAAAAA&

 

[melissavealey]

There are payable codes for 80305, G89.4, G89.29, Z51.81 are a few yes you need the QW

 

[Brit05]

Does anyone get this medical necessity for UMR(uhc) we billed 80305 with dx code f19.20