Revised CR 12131- Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits

CMS revised this article to reflect a revised CR 12131. The CR revision added important information about the use of the QW modifier. CMS added that information in red print. Also, revised the CR release date, transmittal number, and the web address of the CR. All other information remains the same.

Note: CR 12131 isn’t intended to rescind or replace any previous instructions indicating that a laboratory with a valid CLIA certificate of waiver or CLIA certificate for provider performed microscopy procedures be allowed to bill the above codes with a QW modifier. MACs will deny payment for a claim with the HCPCS codes mentioned above as subject to CLIA edits to a provider:

• Without a valid current CLIA certificate

• With a CLIA certificate of waiver (certificate type code 2) (when billed without the ‘QW’ modifier)

• With a CLIA certificate for provider-performed microscopy procedures (certificate type code 4) (when billed without the ‘QW’ modifier)

Source: https://www.cms.gov/files/document/mm12131.pdf