Author Topic: Denial for 81000 from Medicare  (Read 6237 times)

PFP Biller

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Denial for 81000 from Medicare
« on: October 25, 2012, 09:03:44 AM »
I started receiving denials from Medicare for Urinalysis w/ micro as "procedure code is inconsistent with modifier used or required modifier is missing." I file all of these with a QW modifier, as we do perform them in office. Does Medicare not require this modifier for this code any longer? Any input would be greatly appreciated! Thanks!

supertaz93

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Re: Denial for 81000 from Medicare
« Reply #1 on: October 25, 2012, 09:24:06 AM »
Regarding the use of Modifier QW
Appropriate Usage:
Any test on the CMS list that CLIA standards are waived for
Inappropriate Usage:
Any code that is not on the CLIA waived test list

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

Cpatel

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Re: Denial for 81000 from Medicare
« Reply #2 on: October 26, 2012, 09:07:20 AM »
We use 81000 very frequent. you do not need modifier for 81000 but your physician should have CLIA number. You can contact your state agency for information on how to get CLIA.

Michele

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Re: Denial for 81000 from Medicare
« Reply #3 on: October 30, 2012, 07:28:12 AM »
I don't believe the 81000 is a CLIA Waived test so the QW will not work.  Did you try looking in the LCD's?
« Last Edit: October 30, 2012, 07:34:05 AM by Michele »
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joyce

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Re: Denial for 81000 from Medicare
« Reply #4 on: October 31, 2012, 09:29:17 AM »
It depends on your CLIA Cert Type, if you have CLIA Cert Type 2 as we do, then use 81002, no modifiers.  We get paid around $3.62 using that coding.