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Medicare procedure code and modifier ?

  1. #1
    Exclamation Medicare procedure code and modifier ?
    Medical Coding Books
    Hello I have a question for everyone, we have a code 87081 which is a rapid strep test. We have billed it by it's self and with a modifier QW both get denied. Does anyone know if this code will payout? And if so how do you bill it? Txs for the help!!!

  2. #2
    North Carolina
    Typically, the rapid strep test is 87880...

    Code 87880 (direct observation) should be used for all immunologically-based commercial Streptococcus Group A testing kits whose interpretation rely on a visual reaction (observed by the naked eye)

  3. #3
    Seacoast- Dover New Hampshire
    If it is going to MCR make sure you use QW with the 87880
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  4. #4
    TXS!!! I really appreaciate it!! Thats what the issue was right modifier, they had the wrong code!!! U guys ROCK!! Tiffany

  5. #5
    Portland, Oregon
    Default modifier QW

    I am knowing that modifier is use for waiwed CLIA test, and 87081 is not on a waived CLIA test. So if you want to bill 87081, you should not use QW modifier. Other way, if you use modifier QW, you must have the correct CLIA number on the claim to be bill.
    This is the sample of some laboratory and pathology that show on Medical Services Aministration (MSA)
    Waived CLIA Test Codes: 81002, 81003QW, 81025, 82465QW, 82947QW, 84703QW, 85013,
    85014QW, and 85018QW
    Physician Performed Microscopy Procedure Codes: 81000, 81001, and 81015
    CLIA Certificate of Compliance/Accreditation Codes: 82948, 85660, 87077, 87081, 87205, 87207,
    87210 and 87270.
    NOTE: Modifier QW designates the procedure as a waived CLIA test.

    Good luck
    Jeslyn CPC-A

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