CMS reminds MACs to check COVID-19 laboratory claims for modifier -QW

CMS released a one-time notification on April 24 to remind Medicare Administrative Contractors (MAC) that claims for novel coronavirus (COVID-19) diagnostic testing codes 87635 and U0002 must include modifier -QW (Clinical Laboratory Improvement Amendments [CLIA] waived test) when submitted by CLIA-waived facilities.

HCPCS Level II code U0002 (2019-nCoV coronavirus, SARS-CoV-2/2019-nCoV [COVID-19], any technique, multiple types or subtypes [includes all targets], non-Center for Disease Control and Prevention [CDC]) and CPT code 87635 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [COVID-19), amplified probe technique) are used to report testing for COVID-19 in laboratories that do not use the CDC test kit.

Typically, clinical laboratories must be CLIA certified to receive Medicare or Medicaid payments for diagnostic testing services. However, the U.S. Food and Drug Administration issued an Emergency Use Authorization that enables facilities having a current CLIA certificate of waiver to perform and bill for these diagnostic tests during the period of the COVID-19 public health emergency. Effective March 20, facilities with a CLIA certificate of waiver may submit claims for codes U0002 and 87635 with HCPCS modifier -QW to be edited at the CLIA certificate level.

MACs should not search their files to retract payment for claims already paid or to retroactively pay claims that adhere to these requirements. However, contractors should adjust non-compliant claims that are brought to their attention, according to CMS.