Pathology/Lab Coding Alert

Question: The lab that I work for has a CLIA Certificate of Compliance. Do I need to use modifier QW when we perform CLIA-waived lab tests?

Washington Subscriber

Answer: No, you do not need to use modifier QW (CLIA waived test) when you're reporting tests that the Clinical Laboratory Improvement Amendments (CLIA) approves for use by waived-status labs.

CLIA defines waived tests as "simple laboratory examinations and procedures that have an insignificant risk of an erroneous result." Labs that operate with a certificate of waiver (COW) are allowed to perform only CLIA-waived tests.

CLIA-waived labs must list most test codes with modifier QW to indicate that the test they're performing is approved for their certification level. Because your lab is certified for more complex tests, you don't have to use the modifier to show that you're operating within the scope of your license.

Also, the following tests don't require modifier QW, even when a CLIA-waived lab performs the test:

• 81002 -- Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; nonautomated, without microscopy

• 81025 -- Urine pregnancy test, by visual color comparison methods

• 82270 and 82272 -- Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; ...

• 82962 -- Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use

• 83026 -- Hemoglobin; by copper sulfate method, non-automated

• 84830 -- Ovulation tests, by visual color comparison methods for human lutenizing hormone

• 85013 -- Blood count; spun microhematocrit

• 85651 -- Sedimentation rate, erythrocyte; nonautomated.

Resource: You can learn more about CLIA certification and find a current list of CLIA-waived tests at www.cms.hhs.gov/CLIA.