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Lab billing - QW and CLIA Certificates?


Best answers
If our lab is certified with a Certificate of Compliance (COC) or Certificate of Accreditation (COA) do we need to use the QW when billing CLIA-waved tests?

I can't find a clear answer on this, but have read on other sites and in industry-specific newsletters that you only need the QW modifier (meaning the tests does not require a higher level CLIA certification) if you have a CLIA Waiver on file. If you have a high level certification like a COC or COA, then you wouldn't need the the QW as you are accredited to perform any level of test and you don't need a waiver on file.

That said, I'm having a terrible time finding an authoritative source that clearly answers this question. I know our Medicare is denying without the QW, but am still not sure we should be putting it on since we aren't working under a waiver, but under a COA.

Any lab billing experts out there?
Thanks! :confused:


Sharpsville, PA
Best answers
Are you finding if you use the QW on a waived test even though you are a higher level lab, that your claims pay or are they denying?

I am looking for the same information and having trouble finding a clear answer as well.