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H-PYLORI TEST AND H-PYLORI BLOOD TEST

Shade Posted Tue 16th of December, 2014 17:30:48 PM

Please confirm if i need to append modifier QW TO 83009 AND 86677 TEST WHEN IT IS DONE IN THE PROVIDER FACILITY.PLEASE PUT MORE CLARITY INTO THIS MODIFIER USAGE FOR ME . THANK YOU.

SuperCoder Answered Tue 16th of December, 2014 18:53:42 PM

Thanks for your question. 83009 and 86677 are not included on the CLIA waved list. The Clinical Laboratory Improvement Amendments (CLIA) affects all laboratories and any practice that has an in-office lab - no matter how small. CLIA establishes three categories of lab tests: waived, moderate complexity, and high complexity. Small, in-office labs commonly have a certificate of waiver that allows them to perform and bill only waived tests.

Every CLIA-waived test code is listed twice on the Medicare fee schedule - once by itself and once with the -QW modifier to indicate the test is CLIA-waived. If your office has a waived lab, you must add modifier -QW (CLIA-waived test) to every waived lab test you report. This modifier tells Medicare your practice has CLIA-waived status and is allowed to bill for the lab code you are reporting.

You can't just append modifier -QW to any lab code and expect to get paid. The code you report must be listed on the fee schedule with -QW. See attached link for the list of CLIA waived tests.

http://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/waivetbl.pdf

Shade Posted Wed 17th of December, 2014 09:37:42 AM

thank you. this is a very informative link. can you send me link to medicare fee schedule. thank you.

SuperCoder Answered Wed 17th of December, 2014 11:40:35 AM

You are welcome. I have attached the CMS fee schedule look up tool. You can use this to enter the codes you want to look up. You can also look up fee schedules via Supercoder site. You can search for the codes at the top of the page and then click on the Fee Schedule tab. This will provide you with the same fee schedule information. Hope this helps.

http://www.cms.gov/apps/physician-fee-schedule/overview.aspx

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