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Thread: QW modifier

  1. #11
    Join Date
    Apr 2007
    Richmond, Indiana


    AAPC: Back to School
    Quote Originally Posted by krdonegan View Post
    You may use the QW modifier for patients with private insurance. I work for a billing office that specializes in treatment facilities, and the QW modifier can be used for ANY CLIA-certified test that is performed, regardless of the patient's insurance.
    During an audit, the outside auditor scored us wrong if we used -QW on a non-Medicare claim. I disagreed. Do you know of any resources to prove my point? Thanks for any help.
    Last edited by plainjane; 09-25-2014 at 02:09 PM.

  2. #12


    Modifier QW Fact Sheet


    CLIA waived test

    Appropriate Usage:

    Any test on the CMS list that CLIA standards are waived for

    Inappropriate Usage:

    Any code that is not on the CLIA waived test list

    The Clinical Laboratory Improvement Amendments (CLIA) of 1988 requires all laboratory testing sites to have one of the following certificates to legally perform clinical laboratory testing:
    Certificate of Waiver
    Certificate of Registration
    Certificate of Accreditation
    Certificate for Physician-Performed Microscopy

    Certain CLIA Certificates that have been issued may limit the holder to perform only certain tests. There are only two types of CLIA certificates that limit holders to certain test procedures:
    Certificate of Waiver
    Certificate of Physician Performed Microscopy Procedures (PPMP)

    If a service is denied as not covered under your CLIA certificate, you may not bill the beneficiary for the service.

    If a provider currently has one Medicare Part B provider number covering more than one clinical lab testing site (e.g., an office on Main Street and an office on Oak Street), both sites require a CLIA number. The provider should use the CLIA number that specifically represents the site where the test(s) was/were performed.
    All clinical diagnostic laboratories must include their CLIA numbers on all claims to avoid an unprocessable rejection. The CLIA number must be placed in Item 23 of the CMS-1500 claim form. Electronic submitters using the ANSI X12 4010 version should use segment 2-180-REF02 (X4).
    Please note: A CLIA Waived Test still requires the provider to include their CLIA number on the claim.
    To be recognized as a waived test, some CLIA waived tests have unique HCPCS procedure codes and some must have a QW modifier included with the HCPCS code. To view the CMS CLIA waived test list, refer to CMS Internet Only Manual (IOM), Publication 100-04, Chapter 16, Section 70.8 (see link listed below).

    CMS Resources

    CMS CLIA webpage

    CMS CLIA waived test list

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