Following changes to the Clinical Laboratory Improvement Amendments (CLIA) regulations, CMS released updated guidance for COVID-19 test billing effective September 23, 2020.
Beginning January 3, 2022, HHSC is requiring providers to include modifier QW when billing for the COVID-19 procedure code 86328 for dates of service on or after September 23, 2020.
All MCOs have until March 25, 2022 to automatically reprocess procedure code 86328 claims submitted with modifier QW with dates of service on or after September 23, 2020 for appropriate payment. Providers may receive additional payment but are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.
The QW modified is a CLIA guidelines requirement for specific procedure codes based on their complexity and must be included on claims that have CLIA-waived procedure codes. Providers must have the required CLIA certification on file, and must use the QW modifier when it is required. Claims will be denied if the QW modified is not present on applicable CLIA-waived tests.
Important: Provider must refer to the CMS CLIA website for information about CLIA-waived tests, provider certifications, and billing requirements.
Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 86328
For additional information, please contact Provider Relations at (210) 358-6294 or ProviderRelations@CFHP.com.
Recent Comments