Wiki 85025 with QW Palmetto/Railroad Denial

[ALozano25]

Any of you guys have been having denials for the 85025 with a qw mod from railroad? When we take off modifier our clearing house states it is required but when we bill it palmetto denied for procedure inconsistent with modifier. Tried looking at the cms guideline and do not see anything where it says not to use the QW. Am I missing something? Any guidance is highly appreciated

 

[erjones147]

If you are trying to bill 85025-QW, then your machine must be CLIA-waived. I only just recently heard about the new CLIA-waived Sysmex.

Otherwise, if you are using the old Sysmex (or equivalent device), then you either need a "moderate complexity" CLIA license, or some privates (never Medicare or Medicare Railroad) will pay a few bucks for 85025-90 for sendout CBCs

If you DO have the new Sysmex and are still getting denied, I would love to hear about it, since my clinic is thinking about purchasing one