CLIA waved Drug Screen

chikida

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Last year, we used G0477-QW for all of our drug screens done in the office (we send them to an outside lab for confirmation). I have tried using 80305-QW and am getting denials stating that modifier is not appropriate with the code. Is there another modifier I should be using for the CLIA waved test or am I not able to bill for our drug screens anymore since we are CLIA waved? Any help would be great! Thanks!
 

tpayne129

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Southaven, MS
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QW Modifier denials

I am having the same problem. When I bill 80305-QW it says invalid modifier, when I bill without the QW it says missing/incomplete/invalid clia cert number. I am stuck!
 

ndebien

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Clarksville, TN
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Answered yet?

Hopefully by now you've received an answer. Medicare's new policy on this CLIA waived test did not go into effect until 4.1.17, to be implemented on 4.3.17. I have just started re-submitting all my 80305-QWs for reprocessing. It's important to make sure you have your referring provider (authorized as a referring provider by Medicare), and your CLIA number on the claim. I haven't received any responses back yet, but fingers crossed they get paid with no issue.
 
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80305 Denails

I have researched and researched and 80305 is still getting denied through Medicare. I have tried it with and without a QW modifier. And I keep getting the same denial reason: "missing/incomplete/invalid clia cert number." It is processing fine through all other insurance companies, but Medicare keeps denying. Pre/post April 2017, I have sent and resent since that date and still no payment for 80305. I have never had trouble getting drug screens paid for in the past. If anyone has figured out why this is getting denied and how to fix it I would greatly appreciate it!
 
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Looks like it was a technical problem

Well I finally got a response from Medicare. Apparently the qualifier on the 1500 form was incorrect. It needs to be an X4. Now just trying to figure out how to fix this on our EMR system and it should go through. So thankful to finally get some answers.
 
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