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Denial for 81000 from Medicare

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PFP Biller:
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:
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:
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:
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?

joyce:
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.

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