Results 1 to 2 of 2

CLIA Question

  1. Default CLIA Question
    Exam Training Packages
    If a practice is CLIA cert do we have to bill the QW or just bill that lab without modifier? Does it make a difference in payment??

    Thanks in advance,

    PPS

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    If the test is CLIA waived, the QW will need to be reported with the CLIA #.

    Laboratory claims submitted without the CLIA number are returned as unprocessable. If the CLIA number is submitted on the claim, but is inconsistent with the CLIA format, the carrier returns the claim as unprocessable. If more than one CLIA number is submitted on the claim, except when a reference laboratory is on the same claim, the carrier returns the claim as unprocessable.

    The CMS identifies CLIA waived tests by providing an updated list of waived tests to the Medicare contractors on a quarterly basis via a Recurring Update Notification. To be recognized as a waived test, some CLIA waived tests have unique HCPCS procedure codes and some must have a QW modifier.

    For a list of specific HCPCS codes subject to CLIA see
    http://www.cms.hhs.gov/CLIA/downloads/waivetbl.pdf

    In addition, the CMS identifies the new HCPCS codes in the 80000 series that are excluded from CLIA edits by providing an updated listing of these tests to the Medicare contractors on an annual basis via a Recurring Update Notification. No CLIA certificate is required for a claim submitted for any test mentioned in the HCPCS codes in the 80000 series that are excluded from CLIA edits list.

    For a list of the specific HCPCS codes in the 80000 series that are excluded from CLIA edits refer to the following Internet site: http://www.cms.hhs.gov/CLIA/downloads/cpt4exc.pdf

    http://www.cms.hhs.gov/manuals/downloads/clm104c16.pdf
    Last edited by RebeccaWoodward*; 01-19-2010 at 01:35 PM.

Similar Threads

  1. CLIA Help?
    By debrooth in forum Dermatology
    Replies: 0
    Last Post: 03-15-2011, 02:38 PM
  2. Clia - mod qw question
    By Partha in forum Pathology & Clinical Laboratory
    Replies: 2
    Last Post: 09-09-2009, 02:21 PM
  3. Clia
    By Partha in forum Medicare Regulations
    Replies: 0
    Last Post: 08-04-2009, 09:03 AM
  4. ASC and CLIA
    By j.berkshire in forum Outpatient Facilities
    Replies: 0
    Last Post: 11-06-2008, 11:45 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.