Last modified: June 16, 2021
If a lab test is billed and it does not match the level of Clinical Laboratory Improvement Amendment (CLIA) certification, we will let you know through a Smart Edit on your 277CA clearinghouse rejection report so you can respond- speeding up claims processing so you get paid faster. CLIA certification level Smart Edits include:
5 levels of CLIA certification:
If your certification level is a certificate of waiver, you may only bill tests granted under waived status.
The use of the QW modifier is necessary when billing a CLIA waived test. If the QW modifier is not included, this indicates you have a higher level of certification. When there are situations like an Emergency Use Authorization (EUA), additional tests may be deemed as CLIA waived tests and also require the QW modifier.
Information on these additional codes can be found through Centers for Medicare and Medicaid Services (CMS) transmittals and Medicare Learning Network (MLN) Matters articles on the CMS website.