Wiki QW modifier-new biller for

[sus008]

I am a new biller for a new practice. The physician is wanting to bill 81003 with QW modifier but we just submitted the CLIA ap. Will private insurance co reimburse for this without the CLIA waiver?

Sus008

 

[hopepg]

81003 is a CLIA waived test so from my understanding you wouldn't have to be CLIA certified to perform/bill that specific code.
If you aren't CLIA certified yet, it's the non CLIA waived tests that you won't get reimbursement on if you perform/bill.

The QW modifier is required on the CLIA waived tests, such as 81003 whether you are CLIA certified or not...except for a few specific codes where the modifier isn't required (even though they are specifically noted as CLIA waived)...see link:
http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=13736

Others may have other information about it, but this is my understanding of it...