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 Code | Effective Date | Description |
|---|---|---|
| 87651QW | November 9, 2020 | Mesa Biotech Accula {Accula Strep A Test} |
| G0475QW | February 7, 2022 | Abbott Diagnostics Determine HIV-1/2 Ag/Ab Combo {Fingerstick whole blood} |
| 80305QW | March 1, 2022 | Noble Medical Inc. Noble Dip Card/Drug Test Cup |
| 82465QW | March 25, 2022 | PTS Panels Cholesterol Test Strips, Polymer Technology Systems Inc. CardioChek Plus Test System {PTS Panels Cholesterol Test Strips} |
| 82010QW, 82962 | April 7, 2022 | Apex Biotechnology Corp. MTM301 Blood Glucose and Ketone Monitoring System |
| 80305QW | May 9, 2022 | T&D Diagnostics Canada Pvt. Ltd. Sienna Multi-Drug Test (Cup and Dip Card) |
| 80305QW | June 1, 2022 | NexScreen Gen2 Multi-Drug Urine Test Cup |
| 80305QW | June 1, 2022 | NexScreen 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 Code | Name | Use |
|---|---|---|
| 81002 | Dipstick or tablet reagent urinalysis—non-automated for bilirubin, glucose, hemoglobin, ketone, leukocytes, nitrite, pH, protein, specific gravity, and urobilinogen | Screening of urine to monitor/diagnose various diseases/conditions, such as diabetes, the state of the kidney or urinary tract, and urinary tract infections |
| 81025 | Urine pregnancy tests by visual color comparison | Diagnosis of pregnancy |
| 82270 82272 (Contact your MAC for claims instructions) | Fecal occult blood | Detection of blood in feces from whatever cause, benign or malignant (colorectal cancer screening) |
| 82962 | Blood glucose by glucose monitoring devices cleared by FDA for home use | Monitoring of blood glucose levels |
| 83026 | Hemoglobin by copper sulfate – nonautomated | Monitor hemoglobin level in blood |
| 84830 | Ovulation tests by visual color comparison for human luteinizing hormone | Detection of ovulation (optimal for conception) |
| 85013 | Blood count; spun microhematocrit | Screen for anemia |
| 85651 | Erythrocyte sedimentation rate – nonautomated | Nonspecific screening test for inflammatory activity, increased for majority of infections, and most cases of carcinoma and leukemia |