QW Modifier Required for COVID-19 Testing Procedure Code 87636

June 24, 2021

What is new?
Effective July 1, 2021, Texas Medicaid and Healthcare Partnership (TMHP) Learn more about third-party links advised that claims with procedure code 87636 will require the QW modifier for dates of service on or after Oct. 6, 2020.

How will claims reprocess?
Claims submitted with procedure code 87636 and modifier QW with dates of service on or after Oct. 6, 2020, will be automatically reprocessed for appropriate payment no later than July 27, 2021. Providers may receive an additional payment.

Claims will be denied if the QW modifier is not present on applicable Clinical laboratory Improvement Amendment (CLIA) CLIA-waived test. You must have the required CLIA certification on file, and the QW modifier must be used when required, per the Centers for Medicare and Medicaid Services (CMS).

You are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.

Additional Information
Visit the CMS Learn more about third-party links website for additional information regarding CLIA-waived tests, provider certifications and billing requirements.

Have questions
Contact our BCBSTX Medicaid Provider Service Center at 1-877-560-8055 or contact your BCBSTX Medicaid Provider Network Representative at 1-855-212-1615.

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