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QW and 90 modifiers

Tammy Posted Mon 05th of August, 2013 16:41:25 PM

Using 90 instead of QW on commercial claims. Is this correct for commercial payers? or can commercial payers also use QW?

If a provider within a network buys their own eqipment and doing the testing...Is it correct that they are doing the 80061 and 85610 in house and that the QW is appropriate? thanks!

Tammy Posted Tue 06th of August, 2013 18:26:04 PM

Is QW for medicare pt only? thanks!

SuperCoder Answered Wed 07th of August, 2013 16:01:34 PM

Modifier QW indicates that the test is on the list of approved CLIA waived tests. Modifier 90 means that the test was performed by a reference lab, and has nothing to do with CLIA waived testing. It should not substitute for QW for commercial payers.

85610QW and 80061QW are approved codes if you’re performing the tests yourself in a lab with a CLIA certificate of waiver.

QW should not be for Medicare patients only, because all labs must operate with a specific CLIA license regardless of the payer. Contact specific payers for billing requirements regarding modifier QW.

Tammy Posted Wed 07th of August, 2013 18:07:23 PM

Thank you so much!!!!!

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