What modifier is required for Medicare claims for tests performed at a site with a CLIA Waived certificate?

The correct answer to the question regarding the appropriate modifier required for Medicare claims for tests performed at a site with a CLIA Waived certificate is the QW modifier.

CLIA, which stands for the Clinical Laboratory Improvement Amendments, establishes quality standards for laboratory testing to ensure accuracy and reliability. Tests that fall under the CLIA Waived certificate are those that have been deemed to have a lower risk for inaccurate results, allowing certain facilities to perform them with minimal regulations.

The QW modifier specifically indicates that the laboratory tests being billed are performed under a CLIA Waived certificate. When healthcare providers submit claims to Medicare for these types of tests, they must append the QW modifier to the appropriate procedure codes to communicate that the testing facility operates under this less stringent certification. This is important for reimbursement and compliance, as it informs Medicare that the tests adhere to the necessary standards for waived testing.

Utilizing this modifier ensures that the claims are processed correctly, allowing for appropriate reimbursement for services rendered in a compliant manner.