ED Coding & Reimbursement Alert - 2014 Issue 5
Reader Question: Know When Modifier QW Applies
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Article Overview
This reader Q&A covers the use of CLIA-waived test reporting in a physician-office laboratory, including the relationship between CLIA waiver status, FDA-categorized waived tests, and modifier usage. It is intended for coders, billers, and laboratory staff who work with physician-office lab services and want to understand the general scope of guidance around Medicare and other payers. The article also points readers to the CMS CLIA waived test list and notes that the list is updated quarterly.
Why This Topic Matters
Accurate modifier reporting affects how laboratory tests are processed and understood across payers, especially when CLIA waiver status is involved. This topic is relevant for avoiding mismatches between the testing site, the test category, and the reported modifier.
What You Will Learn
- How CLIA waiver status relates to laboratory test reporting
- What general situations are associated with modifier QW
- How modifier 90 is distinguished at a high level
- Where to look for the current CMS CLIA waived test list
Who Should Read This
- Medical coders
- Billing staff
- Laboratory staff
- Physician office practice staff
Codes Discussed
Modifiers Discussed
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