Medicaid Washington – Apple Health Provider Alert

Effective for claims with dates of service on and after February 21, 2022, HCA updated the COVID-19 testing clinical policy as follows:

• Added information on modifier QW.
  • Providers may use this modifier to indicate a diagnostic laboratory service is a Clinical Laboratory Improvement Amendment (CLIA)-waived test and that they have a Certificate of Waiver.
  • Providers may include the QW modifier when appropriate.
• Added CPT® code 87913 to the PCR Tests table.

Added that COVID-19 antibody tests do not need to be performed by a CLIA-certified laboratory if the test is designated by the Food and Drug Administration (FDA) as a CLIA-waived test.

Source: https://www.hca.wa.gov/assets/billers-and-providers/apple-health-covid-testing-clinical-policy.pdf