88305 w/ QW modifier

[mbellar]

Borodin is denying 88305 stating QW modifier needs to be on claim. Claim was filed with Clia#, is this something new anyone can assist with?

 

[mbellar]

Borodin is denying 88305 stating QW modifier needs to be on claim. Claim was filed with Clia#, is this something new anyone can assist with?

Noridian

 

[SharonCollachi]

I'm not sure what your question is, did you bill it with QW? Is it a QW approved test? Do you understand what a QW means?

QW
The modifier is used to identify waived tests and must be submitted in the first modifier field. CLIA waived tests requiring the QW modifier are considered simplified analysis tests. CLIA requires all laboratory testing sites to have one of the following certificates to legally perform clinical laboratory testing:
-Certificate of waiver
-Certificate of registration
-Certificate of accreditation
-Certificate for physician-performed microscopy

Certain CLIA certificates that have been issued may limit the holder to perform only certain test; these are:
-Certificate of waiver
-Certificate of physician performed microscopy procedures (PMPP)

If a provider currently has one Medicare Part B provider number covering more than one clinical lab testing site (e.g., an office on Main Street and an office on Oak Street), both sites require a CLIA number. The provider should use the CLIA number that specifically represents the site where the test(s) was/were performed.

All clinical diagnostic laboratories must include their CLIA numbers on all claims to avoid an unprocessable rejection. The CLIA number must be placed in Item 23 of the CMS-1500 claim form or the electronic equivalent. Note: The CLIA number is not required on the ASC X12 institutional claim data set or its related paper Form CMS-1450.

 

[mbellar]

The claim is being file 88305 with no modifier
Medicare is denying stating claim must be submitted adding mod QW?
Clia # is on the claim

 

[SharonCollachi]

Then add the modifier.