Wiki QW modifier on 80305

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Cavalier40

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Stuart, FL Sailfish Chapter
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I have been getting denials on the 80305 urine drug screen because I have been billing it with the QW modifier as I did with the G codes. Does CPT not require the presence of a CLIA waiver? Or are the insurance companies still catching up?
 
I have also been getting denials from Medicare stating procedure code is inconsistent with the modifier used. Has anyone seen this problem and took off the modifier with payment? I have rebilled this to Medicare because of a CLIA issue and really don't want to resend all until I can get an answer. :)
 
Re-Submitting

Medicare's policy on the new CLIA waved code (80305) was not effective until 4.1.17, to be implemented on 4.3.17. You should have received denials on the code billed without the modifier -QW indicating the type of provider is ineligible. I have just started rebilling all my 80305-QW's, but haven't received a response back yet. I'm hoping they will be processed and paid from here on out. If they do not get paid, I will be sending in a reconsideration request with copies of the article MLN Matters Number: MM9956, which states: "MACs will not search their files to either retract or retroactively pay claims based on these changes. However, MACs should adjust claims that you bring to their attention."

-CPB, 10 yrs experience.
 
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