Showing posts with label QW modifier. Show all posts
Showing posts with label QW modifier. Show all posts

Wednesday, October 15, 2014

QW modifier- List of CPT which Required


QW - CLIA WAIVED TEST 

The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations require a facility to be appropriately certified for each test performed. To ensure that Medicare & Medicaid only pay for laboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate of waiver, laboratory claims are currently edited at the CLIA certificate level.


The Current Procedural Terminology (CPT) codes that the Centers for Medicare & Medicaid Services (CMS) consider to be laboratory tests under CLIA (and thus requiring certification) change each year. Change Request (CR) 8805 informs the MACs about the latest new CPT codes that are subject to CLIA edits. Make sure your billing staffs are aware of these latest CLIA-related changes, and that you remain current with certification requirements.


Listed below are the latest tests approved by the Food and Drug Administration (FDA) as waived tests under CLIA. The CPT codes for the following new tests must have the modifier QW (CLIA-waived test) to be recognized as a waived test. However, the tests mentioned on the first page of the list attached to CR8805 (i.e., CPT codes: 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, and 85651) do not require a QW modifier to be recognized as a waived test.

The CPT code, effective date and description for the latest tests approved by the FDA as waived tests under CLIA are the following:


• G0434QW, September 6, 2013, BTNX Inc. Rapid Response Multi-Drug Urine Test Cup;

• G0434QW, September 6, 2013, BTNX Inc. Rapid Response Multi-Drug Urine Test Panel;

• G0434QW, October 4, 2013, uVera Diagnostics, Inc. CR2 Multi-Drug Urine Test Cup;

• G0434QW, October 4, 2013, uVera Diagnostics, Inc. CR3 Multi-Drug Urine Test Cup;

• G0434QW, October 4, 2013, uVera Diagnostics, Inc. SMARTOX U3 Multi-Drug Urine Test Cup;

• G0434QW, October 24, 2013, American Institute of Toxicology, Inc., AIT Laboratories Drug of Abuse Cup;

• 80061QW, 82962, 82465QW, 83718QW, 84478QW, November 12, 2013, Jant Pharmacal Corp, LipidPlus Professional Lipid Profile and Glucose Measuring System (LipidPlus Lipid Profile test strips);

• G0434QW, December 4, 2013, Nobel Medical Inc. INSTA-SCREEN Multi-Drug Urine Test Cup;

• G0434QW, December 5, 2013, Micro Distributing II, LTD One Step Multi-Drug Urine Test Panel;

• G0434QW, February 11, 2014, Alfa Scientific Designs, Inc. Confidential Drug Test – Multi Drugs of Abuse Urine Test (OTC);

• 87880QW, February 18, 2014, BD Veritor System for Rapid Detection of Group A Strep (direct from throat swab);

• 85018QW, February 18, 2014, Clarity HbCheck Hemoglobin Testing System;

• 87077QW, February 18, 2014, Jant Accutest Rapid Urease test (H. pylori detection);

• G0434QW, March 13, 2014, UCP Biosciences, Inc. UCP Multi-Drug Test Key Cups;

• 83986QW, March 18, 2014, RightBio Metrics, RightSpot Infant pH Indicator;

• 83986QW, March 18, 2014, RightBio Metrics, RightSpot pH Detector;

• 83986QW, March 18, 2014, RightBio Metrics, RightSpot pH Indicator;

• 85018QW, March 21,2014, AimStrip Hb Hemoglobin (Hb) Testing System;

• G0434QW, April 11, 2014, PTox Drug Screen Cup {Cassette Dip Card format};

• 86308QW, April 22, 2014, Polymedco Polystat Mono {whole blood};

• 82274QW, G0328QW, April 22, 2014, Rapid Response(TM) FIT-Fecal Immunochemical Test;

• 84443QW, May 16, 2014, Germaine Laboratories, Inc. AimStep Thyroid Screen {whole
blood};

• 82055QW, May 21, 2014, Express Diagnostics International, Incorporated Saliva Alcohol Test;

• 83037QW, May 22, 2014, BIO-RAD in2it (II) System Analyzer Prescription Home Use;
and

• 87880QW, May 23, 2014, Accustrip Strep A {Specimen type (Throat Swab)}.

You should be aware that your MAC will not search their files, to either retract payment or retroactively pay claims; however, they should adjust such claims that you bring to their attention.


The latest tests approved by the FDA as waived tests under CLIA are listed in the tables that follows. The Current Procedural Terminology (CPT) codes for these new tests in Table 1 must have the modifier ‘QW’ to be recognized as a waived test

CPT requires QW modifier





New CPT codes required QW Modifier

Background

CLIA regulations require a facility to be appropriately certified for each test it performs. To ensure that Medicare & Medicaid only pay for laboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate of waiver, laboratory claims are currently edited at the CLIA certificate level. 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 included with the HCPCS code.

Listed below are the latest tests approved by the Food and Drug Administration as waived tests under CLIA. The Current Procedural Terminology (CPT) codes for the following new tests must have the modifier QW to be recognized as a waived test.


However, the tests mentioned on the first page of the attachment to CR 6370 at http://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/downloads/R1689CP.pdf on the CMS website (i.e., CPT codes: 81002, 81025, 82270, 82272, G0394, 82962, 83026, 84830, 85013, and 85651) do not require a QW modifier to be recognized as a waived test. 

Friday, April 1, 2011

CPT CODE G0431 WITH MODIFIER QW

Qualitative Drug Testing G0431 & G0431 QW

G0431 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

This HCPCS code must be used when reporting any qualitative single drug or drug class assay. This includes individual drug or drug class assays performed using CLIA moderate or high complexity instruments as well as point of care devices which produce results for only one drug or class of drugs.

Medicare reimbursement for G0431 will continue to be $19.72.

G0431QW – Drug screen, qualitative; single drug class method (e.g., immunoassay,
enzyme assay), each drug class, CLIA waived test

This new HCPCS code will become effective April 1, 2010, and must be used when reporting qualitative, single drug class assays classified as “CLIA waived” by the
FDA.

Medicare reimbursement for G0431QW will be $19.72 after April 1, 2010. A key difference between codes G0430 and G0431 is that G0430 is reported per procedure, while G0431 is reported for each drug class. Also, G0430 applies only to non-chromatographic methods, while G0431 can be used for any method.

The definition of a procedure is typically a single device (such as a test cup, test strip or card) or a separate set of reagents used with an instrument to produce one or more test results. Thus, G0431 would be used to report individual drugs or drug classes determined using immunoassay instruments employing discrete reagent sets. The code would be reported once for each drug or drug class determined.

Likewise, if more than one point-of-care test device for a single drug or single drug class is employed, the test results from each device would be separately reported using G0431. At present CMS has assigned no frequency limits for G0430 and G0431. Since these are new codes, they have not yet been assigned Correct Coding Initiative frequency limits (MUEs). It is expected that, in the near future, G0430 will be assigned an MUE value of 1 since CMS would not expect the code to be reported more than one time for each date of service. G0431 will probably be assigned a higher, but unpublished, frequency limit. It is CMS policy to keep frequency limits they believe may be abused confidential. Medically necessary services that exceed MUE frequency limits may be reported as
separate line items using an appropriate modifier such as 59 (separate and distinct service) or 91 (repeat clinical test) to identify them as medically necessary. Since each line of a claim is individually adjudicated, this allows the MUE edit to be bypassed and all medically necessary codes to be paid. However, excessive use of the 59 modifier to bypass MUE edits has been targeted by the Office of Inspector General as a possibly abusive practice. Thus, care should be taken to document medical necessity of such tests in the patient record.

HCPCS codes G0430QW and G0431QW may be used to report any test cleared by the FDA as “waived”. Any correctly coded, medically necessary assay currently cleared by  the FDA should be reimbursed by Medicare/Medicaid contractors after April 1, 2010. The following table summarizes the use of qualitative drug testing codes for Medicare claims submitted after April 1, 2010.

CLIA Waived Modifier QW
CLIA Non-waived
Chromatography:
Multiple drug classes N/A* 80100
Single drug or drug class G0431QW G0431

Other methods:

Multiple drug classes G0430QW G0430
Single drug or drug class G0431QW G0431

*there are no CLIA waived, chromatographic, qualitative drug procedures, thus 80100QW is not included on the Medicare Laboratory Fee Schedule.

Sunday, December 19, 2010

CPT g0430 WITH modifier qw

CPT G0430 & G0430 QW

G0430 – Drug screen, qualitative; multiple drug classes other than chromatographic
method, each procedure

This HCPCS code must be used when reporting any qualitative, non-chromatographic,
multiple drug class assays. The code is reported only once per procedure. Urine cups,
test cards, test strips or other point-of-care devices which provide results for more than
one class of drug will be paid only $20.83 no matter how many drug classes are
determined.

Medicare reimbursement for G0430 will continue to be $20.83.

G0430QW – Drug screen, qualitative; multiple drug classes other than chromatographic
method, each procedure, CLIA waived test.

This new HCPCS code will become effective April 1, 2010, and must be used when
reporting qualitative, non-chromatographic, multiple drug class assays classified as
“CLIA waived” by the FDA.

Medicare reimbursement for G0430QW will be $20.83 after April 1, 2010.

Thursday, December 16, 2010

Qualitative Drug Testing - CPT 80100, 80101 with QW modifier

CMS Guidance on Qualitative Drug Testing March 25, 2010

On March 19, the Centers for Medicare and Medicaid Services (CMS) issued Transmittal
653, Change Request 6852, providing special instructions for billing Qualitative drug
tests using the following specific HCPCS codes:

80100 – Drug screen, qualitative; multiple drug classes chromatographic method, each
procedure

This CPT code remains unchanged and is to be used to report all multiple drug class
assays employing chromatographic methods. It can be reported once for each procedure
(i.e. unique combination of stationary and mobile phase) employed.

Medicare reimbursement will continue to be $20.83.

80101 – Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme
assay), each drug class

This CPT code will no longer be covered by Medicare after April 1, 2010, but will remain
available for use by non-government payers.

80101 QW – Drug screen, qualitative; single drug class method (e.g., immunoassay,
enzyme assay), each drug class, CLIA waived test.

This code will be deleted from the Medicare Laboratory Fee Schedule effective April 1,
2010.

Thursday, November 18, 2010

Modifier QW - CLIA Waived Test

Modifier QW Fact Sheet

QW CLIA Waived Test 

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 require all laboratory testing sites to have one of the following certificates to legally perform clinical laboratory testing:

Certificate of Waiver          -  Certificate of Accreditation
Certificate of Registration -  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.

• CLIA waived tests must have the modifier QW to be recognized as a waived test.

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