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Tag Archives: Modifier

QW modifier

I work at a university student health center and our lab has the designation of high complexity regarding tests we are able to perform. Does anyone know if I need to add the QW modifier to our lab tests that are listed in the waived status under CLIA? Since we are approved for high complexity testing I wasn’t sure if the waived status under CLIA would apply to us. Thanks!

Medical Billing and Coding Forum – Modifiers

Modifier q6

This is my first time using a locum, she is filling in for my audiologist. I am using modifier Q6 attached to CPT 92557 & CPT 92567 and I am getting denial from Medicare reason code 4 – The procedure code is inconsistent with the modifier used or required modifier is missing. Do I need a second modifier? I can not find any current info on the Medicare website & what I do find is not clear. Any help would be greatly appreciated!

Medical Billing and Coding Forum – Modifiers

Modifier 91

I recently coded a pathology service with over 10 units of 88305. This was billed with all the units on 1 line. The carrier denied the entire amount stating 8 units is the limit and advised re billing with 8 units and adding modifier 91 on the next line with the remaining units. Has anyone used modifier 91 for the pathologist/professional component and what has your outcome been? Any thoughts, comments and suggestions would be appreciated!

Medical Billing and Coding Forum – Pathology & Clinical Laboratory

Modifier 26

I have a question? When billing for pathology services for a procedure that was done in POS 24 are we to apply the modifier 26? Our office is receiving denials when billing for the services with a global. The denial states that the technical component was covered under the facility charges. When researching Medicare the only documentation I can find states when the POS is 21 or 22 the pathology lab may only bill for the professional component of a pathology. Can anyone assist me with this ? :confused:

Medical Billing and Coding Forum – Pathology & Clinical Laboratory

New Values for Incomplete Colonoscopies Billed with Modifier 53

An incomplete colonoscopy, e.g., the inability to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, is billed and paid using colonoscopy through stoma code 44388, colonoscopy code 45378, and screening colonoscopy codes G0105 and G0121 with modifier “-53.” (Code 44388 is valid with modifier 53 beginning January 1, 2016.) The Medicare physician fee schedule database has specific values for codes 44388-53, 45378-53, G0105-53 and G0121-53. An incomplete colonoscopy performed prior to January 1, 2016, is paid at the same rate as a sigmoidoscopy. Beginning January 1, 2016,

Medicare will pay for the interrupted colonoscopy at a rate that is calculated using one-half the value of the inputs for the codes.


Coding Ahead

[Announcement] Change for the use of JW Modifier

[UPDATE 6/1/2016: CMS announced a delay in implementing Change Request 9603 to January 1, 2017]

Effective January 1, 2017, when processing claims for drugs and biologicals (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals (CAP), local contractors shall require the use of the modifier JW to identify unused drugs or biologicals from single use vials or single use packages that are appropriately discarded. This modifier, billed on a separate line, will provide payment for the amount of discarded drug or biological.

What is the Current Policy?

The current policy allows contractors the discretion to determine whether to require the JW modifier for any claims with discarded drugs or biologicals, and the specific details regarding how the discarded drug or biological information should be documented. In order to more effectively identify and monitor billing and payment for discarded drugs and biologicals, CMS is revising this policy to require the uniform use of the JW modifier for all claims with discarded Part B drugs and biologicals.

For Example

A single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and 5 units discarded. The 95 unit dose is billed on one line, while the discarded 5 units shall be billed on another line by using the JW modifier. Both line items would be processed for payment. Providers must record the discarded amounts of drugs and biologicals in the patient’s medical record.

The JW modifier is only applied to the amount of drug or biological that is discarded. A situation in which the JW modifier is not permitted is when the actual dose of the drug or biological administered is less than the billing unit. For example, one billing unit for a drug is equal to 10mg of the drug in a single use vial. A 7mg dose is administered to a patient while 3mg of the remaining drug is discarded. The 7mg dose is billed using one billing unit that represents 10mg on a single line item. The single line item of 1 unit would be processed for payment of the total 10mg of drug administered and discarded. Billing another unit on a separate line item with the JW modifier for the discarded 3mg of drug is not permitted because it would result in overpayment. Therefore, when the billing unit is equal to or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted.

CAP Drugs

The JW modifier is not used on claims for CAP drugs. For CAP drugs, see subsection 100.2.9 – Submission of Claims With the Modifier JW, “Drug or Biological Amount Discarded/Not Administered to Any Patient”, for additional discussion of the discarded remainder of a vial or other packaged drug or biological in the CAP.


Multi-use vials are not subject to payment for discarded amounts of drug or biological.


[PDF] CMS transmittal 3530, Change Request 9603: Click Here

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