Wiki Covid test 87636 gets a QW per Medicare effective 7/1/2021

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Addition of the QW Modifier to HCPCS Code 87636​

MLN Matters Number: MM12269
Related CR Release Date: April 26, 2021
Related CR Transmittal Number: R10732OTN
Related Change Request (CR) Number: 12269
Effective Date: July 1, 2021
Implementation Date: July 6, 2021


CR 12269 informs you of the addition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code 87636 [Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique]. CMS included HCPCS code 87636 in Transmittal R10575CP (CR 12080) with an effective date of October 6, 2020. Make sure your billing staffs are aware of this change.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)12269
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Hi Sharon,

I work at an urgent care and we have billed cpt 87636 QW to Medicare and it has still denied, could this because of our CLIA?
 
Hi Sharon,

I work at an urgent care and we have billed cpt 87636 QW to Medicare and it has still denied, could this because of our CLIA?
If you don't have a CLIA waiver number, or it is not attached to the claim, that would certainly cause it to deny.
 
Is anyone having problems with Aetna denying 87636? From my experience, they are appending a 26 modifier after the QW we put one that line and the deny the claim. I recall reading somewhere that this code should not be split by the professional and technical component, any idea where I can find this?
 
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