Wiki CPT 80305 NO Modifer til April 1 2017- after April 1 2017 bill w/ QW modifier?

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CPT 80305 NO Modifer til April 1 2017- after April 1 2017 bill w/ QW modifier?

Medicare replaced the G0477 HCPCS Level II drug screen code with 80305 effective April 1, 2017. Last year, Medicare added the G0477 code effective April 1 and began paying for claims with the QW CLIA waived test modifier appended. As 80305 only became effective April 1 of this year, all claims with 80305-QW were denied during the 1st quarter of 2017. Rejected claims can be resubmitted now that April 1 has passed. Contact your payer if there are any problems.

smbllc

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Hello, My question is about Drug Screens. I know Medicare has replaced G0477 with 80305 effective 1/1/2017, but the PDF says its effective date is April 1, 2017. They did the same thing last year when they replaced G0434 with G0477. I do remember that having an effective date of April 1, 2016 (found PDF below) and that is when I had to start adding the QW modifier on April 1, 2016. I have billed Medicare with 80305 and added QW modifer and I am being denied. My real question is Has anyone billed with NO modifer and gotten paid for 80305? I know the modifer will be in place after April 1st, 2017 just not sure if it will still deny or if they will come back and pay them later if I bill it without the Modifier until April 2017. In 2016 I billed G0477 without modifier until April 1 2016 and Medicare paid.

My denial reason from Medicare when billing 80305 QW: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

Effective April 1, 2017 https://www.cms.gov/Outreach-and-Edu...ads/MM9956.pdf
Effective April 1, 2016 https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9515.pdf
 

cahill12947

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80305 Billing

Hello All:

I have billed it both ways and keep getting the same error message as you. If someone has been successful please advise.
 

pdemore

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80305 Billing

I have also had 80305 denied both with and without. The same thing happened for me in 2016. They wouldn't pay either way until April.
 

ndebien

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I have also received denials. With modifier -QW it tells me invalid modifier. Without it I get denial B7-provider not certified/eligible to be paid for this procedure; with N570-missing/incomplete/invalid credentialing data. He should be good to bill this code. Hoping somebody comes up with a different answer ::fingers crossed::
 

teatsie

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QW modifier

I am a bit new to the lab billing field. Can someone help me understand when the QW modifier needs to be applied to a lab?
 

NishaJ

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Medicare will not be paying this code until 4/1/17.We can resubmitted with QW modifier in the month of April 2017.
80305-QW will be valid only after April 1/17.
 
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ghill

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We are getting the same denial whether we use the QW or not. I talked to a Medicare rep & she said Medicare will not be paying for this code until April 1st. Hope this helps!
 

leahbear

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Well this stinks. I had no trouble with G0477 last year with our Medicare carrier but Palmetto (RR) has already denied my first 80305 this year. The claims at my local carrier are all still pending. This is ridiculous!
 

pompar

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We are still having denials on the G0477's from 2016. We are submitting them with the QW modifier. They deny as procedure code/modifier incorrect? How did you get your G0477's paid in 2016? These codes are only denying in one of our billing offices; there are offices in different towns.
 

newfiegirl

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80305

I'm new to this code as well and my provider is also using 99000 lab handling fee. I did not think that the 99000 should be used also. Please help explain. Thanks,
 

CodingKing

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I'm new to this code as well and my provider is also using 99000 lab handling fee. I did not think that the 99000 should be used also. Please help explain. Thanks,

99000 is not used for in house lab work. Its only when sent to a clinical lab who will in turn be doing the billing. Typically it doesnt pay any extra.
 

erjones147

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I am a bit new to the lab billing field. Can someone help me understand when the QW modifier needs to be applied to a lab?
You use the QW modifier when it is a lab you can do in-house AND you have a certificate from the CLIA organization, which you would only get from submitting an application listing your lab director and your CLIA-waived devices.

For example, we can do rapid HIV screens in house because we told CLIA/CMS the name of the test and the machine in an addendum to our original application, but we cannot do CBCs even though we have the machine, because we are not yet certified by CMS to do moderate complexity labs

The only 2 labs I can think of that require no modifier for us are 82962 and 81025
 

dharman3525

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80305

To QW or NOT?

So many denials on this code. Has anyone found policy-payment documentation on how to process post April 1 2017?
 
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