Primary Care Coding Alert
Wa(i)ve Goodbye to This Modifier for PTH Testing
Question: Medicare has repeatedly denied our claim for 83970 due to modifier QW. Is this the wrong modifier? Codify Subscriber Answer: HCPCS modifier QW (CLIA waived test) is an informational modifier used on lab tests that are deemed to be simple tests with a low risk for an incorrect result. A test 鈥渕ight meet the statutory criteria for CLIA waiver if 鈥� the sponsor demonstrates in studies conducted at the intended use sites that the test is accurate and poses an insignificant risk of erroneous results,鈥� according to the Food and Drug Administration (FDA) (Source: ). Once a test has been granted a CLIA waiver, it is then entered into a Centers for Medicare & Medicaid Services (CMS) database, which you can find at: . Tests on the list can then be performed by labs who have received a certificate of waiver from CMS, and many of the tests on the list require the QW modifier. The test that you have claimed, 83970 (Parathormone (parathyroid hormone)), a test used to measure the level of parathyroid hormone (PTH) in a patient鈥檚 blood, has not received a CLIA waiver. This means that the test cannot be performed by a lab that has only been awarded a certificate of waiver. Additionally, by extension, the QW modifier cannot be appended to this test. 
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