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QW Modifier Required for COVID-19 Testing Procedure Code 86328

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Following changes to the Clinical Laboratory Improvement Amendments (CLIA) regulations, the Centers for Medicare and Medicaid Services (CMS) has released updated guidance for COVID-19 test billing effective September 23, 2020.

Effective for dates of service on or after September 23, 2020, COVID-19 testing procedure code 86328 will require the modifier QW when billed. Affected claims submitted with dates of service on or after September 23, 2020, may be reprocessed. When the claims are reprocessed, providers may receive additional payment, which will be reflected on Remittance and Status Reports.

Note: Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.

For more information about procedure code 86328, providers can refer to the article titled “Additional Information for Coronavirus Testing Procedure Codes,” which was published on the TMHP website.

Reminder: Providers must have the required CLIA certification on file, and they must use the QW modifier when it is required, per CMS. Claims will be denied if the QW modifier is not present on applicable CLIA-waived tests. Providers must refer to the CMS CLIA website for information about CLIA-waived tests, provider certifications, and billing requirements.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.