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QW modifier- new employer now

Many tests, such as measuring a patient’s glucose, have many ways to perform them — quantitative, qualitative, via an assay, via a culture, via a test kit that changes colors. Tests that may be performed via test kit — which do not require a lab tech’s clinical skill, etc.
— can be performed in the office and are placed on the CLIA-waived list. It is important to check the list and make sure that the exact test for glucose that you are performing is on the list, and that you are using the correct CPT code for that test. You don’t want to use the code for “strep test done by culture” without the –QW modifier (and get paid for that service) when you have performed the quick strep test done by kit (87880), which is on the CLIA-waived list. In this case, do two things:

1. Check the CLIA-waived test list and make sure the test/manufacturer is on the list.
2. Check the CPT book and make sure that you select the correct CPT code for that test.

rthames052006

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Hello all,

I am at a new employer now and I am unsure as to why they are using the QW modifier for Medicare claims when they bill a cpt code in the 80000 series, where I used to work we billed for those codes and we never had to use this QW modifier, when I asked why we are using it and what it means because I have never heard of it. I am being told because they were told to, no one knows why but they just do.

I just want to get some clarification on this, since I have no prior experience with it.

I think I will also check my local medicare carrier website to see if I can get a clue.

TIA
 

rthames052006

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Ok, so I checked Medicare's website and I now know that QW= clia waived test, but I am still unclear, I don't mean to sound stupid but the office I came from this wasn't an issue, and at this point no one can tell me why we have to use it... I'm just looking to get some clarification....

Any help will be appreciated.





Hello all,

I am at a new employer now and I am unsure as to why they are using the QW modifier for Medicare claims when they bill a cpt code in the 80000 series, where I used to work we billed for those codes and we never had to use this QW modifier, when I asked why we are using it and what it means because I have never heard of it. I am being told because they were told to, no one knows why but they just do.

I just want to get some clarification on this, since I have no prior experience with it.

I think I will also check my local medicare carrier website to see if I can get a clue.

TIA
 

jharrell

Networker
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We put the QW on some of our 80000 codes that we do in house. We have always wondered if they are suppose to go on all as well and have always been told what you are being told. So I went to look it up and go to the following link and I think this may help. Starting on the 5th page it gives you a list of the codes that require the QW.

Jessica Harrell, CPC
 
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Hi,

CLIA stands for "clinical laboratory improvement amendments". It is a law that establishes quality standards for all laboratory testing (except research) to ensure the accuracy, reliability and timeliness of patient tests. There are all sorts of guidelines & criteria that a "laboratory" must meet. As per CLIA, the definition of a "laboratory" is as follows: "a facility that performs testing on materials derived from the human body for the purpose of providing information for the diagnosis, preventionm, or treatment of any disease or impairment of, or assessment of the health of, human beings."

There are different levels of certificates that are required in order for a facility to do lab tests. The QW modifier states that the tests you are performing are "simple laboratory examinations and procedures that have an insignificant risk of an erroneous result". They are considered "CLIA waived" and therefore require a "CLIA Certificate of Waiver". You can access a complete list of the CLIA waived tests via the link I've included below.

This in a nutshell, I think answers some of your questions. There is more in-depth information that you can find on the CLIA webiste. I've included the link for you below:

http://www.cms.hhs.gov/CLIA/01_Overview.asp#TopOfPage

Hope this helps & Good Luck.
 

rthames052006

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thompsonsyl,

Thank you very much for the info... I appreciate your prompt, clear response, it all makes sense now.

Again thanks



Hi,

CLIA stands for "clinical laboratory improvement amendments". It is a law that establishes quality standards for all laboratory testing (except research) to ensure the accuracy, reliability and timeliness of patient tests. There are all sorts of guidelines & criteria that a "laboratory" must meet. As per CLIA, the definition of a "laboratory" is as follows: "a facility that performs testing on materials derived from the human body for the purpose of providing information for the diagnosis, preventionm, or treatment of any disease or impairment of, or assessment of the health of, human beings."

There are different levels of certificates that are required in order for a facility to do lab tests. The QW modifier states that the tests you are performing are "simple laboratory examinations and procedures that have an insignificant risk of an erroneous result". They are considered "CLIA waived" and therefore require a "CLIA Certificate of Waiver". You can access a complete list of the CLIA waived tests via the link I've included below.

This in a nutshell, I think answers some of your questions. There is more in-depth information that you can find on the CLIA webiste. I've included the link for you below:

http://www.cms.hhs.gov/CLIA/01_Overview.asp#TopOfPage

Hope this helps & Good Luck.
 

taham

Contributor
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Office manager

I need to know do we use qw modifire for lab test only for medicare patient.
 

krdonegan

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Tucson Arizona Chapter
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I need to know do we use qw modifire for lab test only for medicare patient.
You may use the QW modifier for patients with private insurance. I work for a billing office that specializes in treatment facilities, and the QW modifier can be used for ANY CLIA-certified test that is performed, regardless of the patient's insurance.
 

krdonegan

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Tucson Arizona Chapter
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Hi,

CLIA stands for "clinical laboratory improvement amendments". It is a law that establishes quality standards for all laboratory testing (except research) to ensure the accuracy, reliability and timeliness of patient tests. There are all sorts of guidelines & criteria that a "laboratory" must meet. As per CLIA, the definition of a "laboratory" is as follows: "a facility that performs testing on materials derived from the human body for the purpose of providing information for the diagnosis, preventionm, or treatment of any disease or impairment of, or assessment of the health of, human beings."

There are different levels of certificates that are required in order for a facility to do lab tests. The QW modifier states that the tests you are performing are "simple laboratory examinations and procedures that have an insignificant risk of an erroneous result". They are considered "CLIA waived" and therefore require a "CLIA Certificate of Waiver". You can access a complete list of the CLIA waived tests via the link I've included below.

This in a nutshell, I think answers some of your questions. There is more in-depth information that you can find on the CLIA webiste. I've included the link for you below:

http://www.cms.hhs.gov/CLIA/01_Overview.asp#TopOfPage

Hope this helps & Good Luck.
This is a well-worded, brilliant answer. Thank you for taking the time to make it. It has cleared a few of my doubts about CLIA. Thanks again. :)
 

plainjane

New
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You may use the QW modifier for patients with private insurance. I work for a billing office that specializes in treatment facilities, and the QW modifier can be used for ANY CLIA-certified test that is performed, regardless of the patient's insurance.
During an audit, the outside auditor scored us wrong if we used -QW on a non-Medicare claim. I disagreed. Do you know of any resources to prove my point? Thanks for any help.
 
Last edited:

PCAVANESS

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Modifier QW Fact Sheet

Definition

CLIA waived test

Appropriate Usage:

Any test on the CMS list that CLIA standards are waived for


Inappropriate Usage:

Any code that is not on the CLIA waived test list


The Clinical Laboratory Improvement Amendments (CLIA) of 1988 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 tests. There are only two types of CLIA certificates that limit holders to certain test procedures:
Certificate of Waiver
Certificate of Physician Performed Microscopy Procedures (PPMP)


If a service is denied as not covered under your CLIA certificate, you may not bill the beneficiary for the service.

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. Electronic submitters using the ANSI X12 4010 version should use segment 2-180-REF02 (X4).
Please note: A CLIA Waived Test still requires the provider to include their CLIA number on the claim.
To be recognized as a waived test, some CLIA waived tests have unique HCPCS procedure codes and some must have a QW modifier included with the HCPCS code. To view the CMS CLIA waived test list, refer to CMS Internet Only Manual (IOM), Publication 100-04, Chapter 16, Section 70.8 (see link listed below).


CMS Resources

CMS CLIA webpage
http://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/index.html

CMS CLIA waived test list
http://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads//waivetbl.pdf
 
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