AHA Coding Clinic® for HCPCS - 2021 Issue 1; For Your Information
The addition of modifier QW with codes 87811 and 87428
CMS has instructed that Modifier QW, CLIA waived test, is to be appended to the following HCPCS codes: HCPCS Code Code Descriptor 87811 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) 87428 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B As of December 2, 2020, the Food and Drug Administration (FDA) issued two...
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Article Overview
This article covers CMS instructions on attaching modifier QW to specific HCPCS laboratory test codes, along with related FDA EUA and CLIA waiver context. It is intended for coders, billers, compliance staff, and laboratory services teams who need to understand how the affected HCPCS entries are identified and when the guidance is effective. The article also notes that the list of codes requiring the modifier is updated annually.
Why This Topic Matters
Correct identification of HCPCS laboratory tests associated with CLIA-waived settings affects claim processing, compliance, and Medicare/Medicaid payment handling. The article helps readers recognize the relevant code set, the modifier involved, and the policy context behind the update.
What You Will Learn
- The CMS and FDA context for CLIA-waived laboratory testing
- Which HCPCS lab test entries are discussed in the update
- How the article frames effective dates and annual updates
- The general relationship between waiver status and claims processing
Who Should Read This
- Medical coders
- Billers
- Laboratory managers
- Compliance staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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