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80101 Denied for CLIA Certification No.- Help

  1. Smile 80101 Denied for CLIA Certification No.- Help
    Medical Coding Books
    Our pain management doc uses a drug screen dipstick test, CLIA waved, we coded 80101QW x11, for 11 different drug classes.

    But Medicare has denied the claim stating Missing CLIA certification number.
    As CPT 80101 is CLIA waived we have used QW modifier & also added the Product 'multi-CLIN' in 19th block of HCFA-1500 which is kept for Reserve local use. Do we need to add CLIA certification number ? If yes from where we can get it from Physician or from other source ?
    Please help.

  2. Default
    A CLIA waiver number is required on the claim form for all CLIA waived tests. The CLIA waiver is usully issued by the state. If you are in a private practice then your office will have to apply for one. If you have more than 1 office location and the CLIA waived test is done in the other locations you will need a CLIA waiver for each additional location. If you are part of parent company or corporation, the company should have a CLIA waiver for all CLIA waived tests.

    I dont know if the CMS website provides this information about which state dept to contact But you may want to check with your Medicare carrier to see if they have any links or contact information.

    Good luck,

    Dolores, CPC, CCC
    Last edited by deeva456; 04-20-2009 at 03:49 PM.

  3. Default
    Thanks for your help.

    Neha Bhatnagar, CPC, CPC-H

  4. Default
    We have also found that Medicare requires an LCD dx for some CLIA tests.

    Marcia - CPC
    Anesthesia Business Consultants.

  5. Smile
    We as well have a pain management practice that does a lot of these. We are entering the CLIA number in box 23. As long as it is in box 23 we receive payment from Medicare. All other insurance carriers want the CLIA number in box 19.

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