When should the QW modifier be used?

Asked by: Callie Pacocha  |  Last update: August 17, 2023
Score: 4.1/5 (58 votes)

Modifier QW is used to indicate that the diagnostic lab service is a Clinical Laboratory Improvement Amendment (CLIA) waived test and that the provider holds at least a Certificate of Waiver. The provider must be a certificate holder in order to legally perform clinical laboratory testing.

What codes require a QW modifier?

Providers possessing a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Wavier or Provider - Performed Microscopy Procedures (PPMP) must utilize a test kit and bill the program utilizing a QW modifier with for the following codes: 80061, 80101, 81003, 81007,82010, 82044, 82055, 82120, 82273, 82274, ...

What is the proper use of the QW modifier?

How do I know which laboratory tests require modifier QW? Medicare uses modifier QW to indicate that a test is CLIA-waived and the reporting physician's practice has a CLIA certificate that allows the physician to perform and report CLIA-waived tests.

What are CLIA waived tests?

What is waived testing? By the CLIA law, waived tests are those tests that are determined by CDC or FDA to be so simple that there is little risk of error. Some testing methods for glucose and cholesterol are waived along with pregnancy tests, fecal occult blood tests, some urine tests, etc.

Does 87807 require a QW modifier?

And don't forget: As the RSV test is CLIA-waived, you must make sure that you append the modifier QW (CLIA waived test) to the 87807.

Modifier QW CLIA waived tests - how to find CLIA waived CPT codes?

36 related questions found

What category of laboratory tests requires a QW modifier?

The modifier is used to identify waived tests and must be submitted in the first modifier field. CLIA waived tests requiring the QW modifier are considered simplified analysis tests.

What are 3 examples of CLIA waived tests?

As defined by CLIA, waived tests are “simple laboratory examinations and procedures that have an insignificant risk of an erroneous result.” Examples of waived tests include: dipstick urinalysis, fecal occult blood, urine pregnancy tests, and blood glucose monitoring.

What is not considered a CLIA waived test?

Nonwaived Testing. Nonwaived testing is the term used to refer collectively to moderate and high complexity testing. Laboratories or sites that perform these tests need to have a CLIA certificate, be inspected, and must meet the CLIA quality standards described in 42 CFR Subparts H, J, K and M.

What is an example of a waived test?

Examples of waived tests include: Dip stick urinalysis or tablet reagent urinalysis (non-automated or certain automated analyzers) Fecal occult blood.

What is the difference between CLIA and CLIA waived?

Waived tests include test systems cleared by the FDA for home use and those tests approved for waiver under the CLIA criteria. Although CLIA requires that waived tests must be simple and have a low risk for erroneous results, this does not mean that waived tests are completely error-proof.

Does 87880 need a QW modifier?

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The laboratory codes must be reported with modifier -QW to be recognized as a CLIA waived test. 87880-QW, infectious agent antigen detection by immunoassay with direct optical observation; streptococcus, group A.

Is QW modifier required for 81003?

In contrast, some 81003 tests are CLIA-waived while others are not. "You would not use QW for 81003 unless the kit/reagent used to perform the test matches both test name and manufacturer as it appears on the list," says Avery.

Does 81002 require a QW modifier?

HCPCS codes: 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, and 85651) don't require a QW modifier to be recognized as a waived test.

Do all CPT codes require a modifier?

Diagnosis coding always requires the most specific code possible. It may not be necessary to include a modifier if the description is contained in the ICD-10 coding.

Does 87804 require a QW modifier?

Report 87804-QW for Optical Analysis

Use this code for detection by visual identification. Reporting tip: Many Medicaid states require you to follow Medicare modifier guidelines and append modifier QW (CLIA-waived test) to 87804. To keep coding uniform, many practices use modifier QW regardless of payer.

Can modifier 25 be used with labs?

Modifier 25 is only appended to an E/M visit. Not the other services that day.

What are 7 considerations that should be made regarding waived testing?

Considerations Before Introducing Waived Testing or Offering a New Waived Test
  • Management responsibility for testing. ...
  • Regulatory requirements. ...
  • Safety. ...
  • Testing space and facilities. ...
  • Benefits and costs. ...
  • Staffing. ...
  • Documents and records.

Is a rapid strep test a CLIA-waived test?

Both Cardinal Health™ Strep A Rapid Tests are CLIA-waived rapid chromatographic immunoassays for the qualitative detection of Strep A antigen from throat swab specimens to aid in the diagnosis of Group A Streptococcal infection.

What are 2 examples of CLIA-waived chemistry test?

Individual CLIA-waived tests include Glucose, ALT, AST, Total Cholesterol, Triglycerides, HDL, LDL (calculated), BUN, Creatinine, Total Protein.

What are the three categories of testing under CLIA?

The FDA categorizes diagnostic tests by their complexity—from the least to the most complex: waived tests, moderate complexity tests, and high complexity tests.

What is the difference between waived and non waived testing?

Waived tests are simple tests with a low risk for an incorrect result. Nonwaived tests, also called Moderately Complex tests, are those tests that require a number of criteria to be met prior to the operator running the tests.

What is the difference between waived and non waived lab testing?

Waived testing may be performed at the POC or in a centralized facility. Non-waived testing is subcategorized as moderately complex and highly complex. The majority of non-waived POCT is moderately complex. The facility must be diligent regarding adherence to the manufacturer's operating/testing instructions.

Which of the following requirement must be met for a test to be CLIA waived?

Over 1,400 test systems have been waived as they meet the following requirements: Simple, non-technical methodology. Negligible risk of error in results. Pose no harm on the patient even if performed incorrectly.

Is a CBC a CLIA waived test?

It is a CLIA-waived analyzer that is factory calibrated and it will not report values that might be inaccurate. Prior to or during the examination, the patient's blood is drawn and the CBC is performed in your office.

Which CLIA waived tests can be performed by the medical assistant?

Medical Assistants/CNAs: is allowed to engage in the following waived testing: Urinalysis dipstick, Rapid Strep, Hemocue hemoglobin testing and pregnancy testing only after completion of lab competency training, testing and certification by a Boards of Health lab technologist.