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Lab billing - QW and CLIA Certificates?

  1. Question Lab billing - QW and CLIA Certificates?
    Medical Coding Books
    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?

  2. #2
    The only thing I can think of is that Medicare does not have your CLIA number set up to your specific CLIA type or that your CLIA number is not going out on the claims. I would start there first. Here is a website that may help you.

  3. Default
    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.


  4. Default Having same issue....
    Have you found a direct answer to your question?

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