Wiki Modifier QW - Does anyone know

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jflynn

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Does anyone know if the new Medicare UDS codes of G0477/G0478 require the CLIA Waived modifier QW? I don't want claims denied for not adding the modifier or vice versa.

Thanks!
 
g0477 clia waived?

I was curious if anyone has received any denials or payments for this code yet? It isn't on any approved clia waived list I can find so I haven't been using modifier qw. I am hoping someone can give me some insight into this matter.
 
We are filing without QW as we did not find info stating it was CLIA waived but have not gotten any payments or denials as of yet.
ironically our clearinghouse did not update their files with G0477 as a new code so we did have rejects for those we filed first!
 
G0477 denials

kmcfadyen said:
we are filing without qw as we did not find info stating it was clia waived but have not gotten any payments or denials as of yet.
Ironically our clearinghouse did not update their files with g0477 as a new code so we did have rejects for those we filed first!
Click to expand...

i have received denials from medicare as the clia certificate does not allow for the lab to be done
 
MLN came out today on this subject. G0477 is updated to CLIA waived status. Some other retros as well for CY 2015


https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/MM9515.pdf

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/MM9502.pdf

CMS MLN said:
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.
Click to expand...

SO get on the phone with Medicare about those denials
 
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FYI: Both of the referenced MedLearn Matters bulletins indicate that they won't be implemented until April 4, 2016; MM9502 has an effective date of January 1, 2016 but MM9515 has an effective date of April 1, 2016. The current 2016 Medicare Clinical Lab Fee Schedule doesn't have a listing for the G0477-QW option. It will likely be revised with a 2nd quarter 2016 lab fee schedule update.

This "mismatch" is similar to what happened a couple of years ago when G0434 was implemented but it was not set up initially to process as a CLIA-waived code. CMS corrected the issue but not until April 1st.
 
marvelh said:
FYI: Both of the referenced MedLearn Matters bulletins indicate that they won't be implemented until April 4, 2016; MM9502 has an effective date of January 1, 2016 but MM9515 has an effective date of April 1, 2016. The current 2016 Medicare Clinical Lab Fee Schedule doesn't have a listing for the G0477-QW option. It will likely be revised with a 2nd quarter 2016 lab fee schedule update.

This "mismatch" is similar to what happened a couple of years ago when G0434 was implemented but it was not set up initially to process as a CLIA-waived code. CMS corrected the issue but not until April 1st.
Click to expand...

So does this mean that bill without the QW modifier to get Medicare to pay?
 
Until the April 4, 2016, implementation, G0477 with the QW modifier would not be payable by Medicare. Until the implementation date, only G0477 will process for payment.
After the implementation date, for all dates of service on or after 4/1/2016, G0477 will be required by Medicare to have the QW modifier appended if performed by a CLIA waived lab.
 
G0477

anncamp1 said:
SO... I also have been denied G0477. If will bill without QW do we still put the CLIA on it?
Thanks
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Does anyone know the answer to this last question if you charge QW and if you put the CLIA number on it? Do we leave the QW off until after April 1, 2016?
Also, is anyone familiar with the new fee schedule for the code G0477?
 
I would hold your G0477 claims until April, then bill them with the QW modifier. It makes no sense that it will take Medicare that long to update their systems, but it is what it is. The Medicare fee schedule for G0477 is $14-$15 depending on your state.
 
Modifer QW

We are getting denials from Medicare on G0477 with a QW modifier. I have called Medicare and they stated that it was denied because the QW modifier was not valid. We knew to hold claims until April 1st due to the changes in codes, but it is now being rejected. I thought that we have to put the QW since it is CLIA. Please help!!!
 
I am still having the same problem. G0477 is denying with the QW modifier. Our clearinghouse won't allow the claim to go without the QW because they are stating it is required by Medicare per the CMS website. Is anyone else receiving payment yet?
 
The drug testing methods described by G0479, e.g. instrumented chemistry analyzer, TOF, mass spectrometry, etc., would not be CLIA-waived type testing. It would not be appropriate to report QW modifier with G0479.
 
I am STILL getting denials for G0477, with modifier QW. Has anyone YET received payment?!?! I have called Medicare to appeal the claims. I have SOOOO many patients that this has been an issue with. ANY ADVICE WILL HELP! Thank you!
 
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