Modifier QW is defined as a Clinical Laboratory Improvement Amendment (CLIA) waived test. Some things to keep in mind when appending modifier QW to your lab service/s:
The modifier is used to identify waived tests and must be submitted in the first modifier field.
CLIA waived tests requiring the QW modifier are considered simplified analysis tests.
CLIA requires all laboratory testing sites to have one of the following certificates to legally perform clinical laboratory testing:
Certificate of waiver
Certificate of registration
Certificate of accreditation
Certificate for physician-performed microscopy
Certain CLIA certificates that have been issued may limit the holder to perform only certain test; these are:
Certificate of waiver
Certificate of physician performed microscopy procedures (PMPP)
If a provider currently has one Medicare Part B provider number covering more than one clinical lab testing site (e.g., an office on Main Street and an office on Oak Street), both sites require a CLIA number. The provider should use the CLIA number that specifically represents the site where the test(s) was/were performed.
All clinical diagnostic laboratories must include their CLIA numbers on all claims to avoid an unprocessable rejection. The CLIA number must be placed in Item 23 of the CMS-1500 claim form or the electronic equivalent.
CLIA number is not required on the ASC X12 institutional claim data set or its related paper Form CMS-1450.
Note: A CLIA waived test still requires you to include your CLIA number on the claim.
Any test on the CMS CLIA waived test list that has a QW beside the procedure code (i.e., 80047QW).
Any code that is not on the CLIA waived test list.
Any test on the CMS CLIA waived test list that does not have a QW beside the procedure code.
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