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Medicare Part B to Cover New CLIA-Waived Tests on Oct. 1

by | Sep 12, 2022 | News

Make sure your lab billing staff is aware of the changes to ensure full reimbursement.

Make sure your lab billing staff is aware of the eight new CLIA-waived tests the Centers for Medicare & Medicaid Services (CMS) has instructed its Medicare Administrative Contractors (MACs) to recognize, starting October 1, 2022. The following Healthcare Common Procedure Coding System (HCPCS) codes represent tests recently cleared by the FDA. You can get reimbursed for them under Medicare Part B, as long as you list the QW modifier:

HCPCS CodeEffective DateDescription
87651QWNovember 9, 2020Mesa Biotech Accula {Accula Strep A Test}
G0475QWFebruary 7, 2022Abbott Diagnostics Determine HIV-1/2 Ag/Ab Combo {Fingerstick whole blood}
80305QWMarch 1, 2022Noble Medical Inc. Noble Dip Card/Drug Test Cup
82465QWMarch 25, 2022PTS Panels Cholesterol Test Strips, Polymer Technology Systems Inc. CardioChek Plus Test System {PTS Panels Cholesterol Test Strips}
82010QW, 82962April 7, 2022Apex Biotechnology Corp. MTM301 Blood Glucose and Ketone Monitoring System
80305QWMay 9, 2022T&D Diagnostics Canada Pvt. Ltd. Sienna Multi-Drug Test (Cup and Dip
80305QWJune 1, 2022NexScreen Gen2 Multi-Drug Urine Test Cup
80305QWJune 1, 2022NexScreen Gen2 Multi-Drug Urine Test Dip Card

As before, there are also certain CLIA-waived tests produced by multiple manufacturers (and thus have a CPT code rather than a proprietary HCPCS code associated with a single producer). These tests include:

CPT CodeNameUse
81002Dipstick or tablet reagent urinalysis—non-automated for bilirubin, glucose, hemoglobin, ketone, leukocytes, nitrite, pH, protein, specific gravity, and urobilinogenScreening of urine to monitor/diagnose various diseases/conditions, such as diabetes, the state of the kidney or urinary tract, and urinary tract infections
81025Urine pregnancy tests by visual color comparisonDiagnosis of pregnancy
(Contact your MAC for claims
Fecal occult bloodDetection of blood in feces from whatever cause, benign or
malignant (colorectal cancer screening)
82962Blood glucose by glucose monitoring devices cleared by FDA for home useMonitoring of blood glucose levels
83026Hemoglobin by copper sulfate – nonautomatedMonitor hemoglobin level in blood
84830Ovulation tests by visual color comparison for human luteinizing
Detection of ovulation (optimal for conception)
85013Blood count; spun microhematocritScreen for anemia
85651Erythrocyte sedimentation rate – nonautomatedNonspecific screening test for inflammatory activity, increased for
majority of infections, and most cases of carcinoma and leukemia

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