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billing procedure 83037 and 36416

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Need help. Billed Medicare for code 83037- A1C checking by device (modifier QW) and in the instructions to the device said that we need to bill 36416 (modifier QW) in addition to 83037. Unfortunatelly, medicare pay only for 83037 and denies 36416 for "procedure code is inconsistent with he modifier used or a required modifier is missing". Any one knows what should be corrected? Thanks

I'm not sure but I believe the 36416 does not require the QW modifier.

I would suggest that you go on your local Medicare's website and check the fee schedule for clinical labs. It will tell you what the allowable amount is, the effective date and a what the allowable amount would be with and without a modifier.

Here is an example of what the Clinical Lab Fee Schedule looks like:

code 36416 Collection of capillary blood specimen - Procedure Status = B
B = Bundled Code. Payment for covered services are always bundled into payment for other services not specified.  There will be no RVUs or payment amount for these codes, and no separate payment is made.  When these services are covered, payment for them is subsumed by the payment for the services to which they are incident. (An example is a telephone call from a hospital nurse regarding care of a patient).

Modifier QW - if you go to CMS and look up MLN Matters MM7694 this will explain the QW modifier as well as which CPT code can be used with this modifier. 

83037 Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use

83037QW - same as code 83037 above with the addition of the QW modifier for a laboratory registered with only a certificate of waiver under the Clinical Laboratory Improvement Amendments of 1988 (CLIA).

MLN Matters MM4136 explains the QW modifier/procedure.

I think they may have meant the QW mod. to be added to the 83037 and not 36416
Hope this helps

Rev Cardiovasc Med 2003; 4 S3 <a href=>buying cialis online safely</a>


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