Update to COVID-19 Testing Billing Procedure Code 87637 with QW Modifier
Background
Effective July 6, 2021, Texas Medicaid and Healthcare Partnership (TMHP) 
advised that claims with procedure code 87637 will require the QW modifier for dates of service on or after Oct. 6, 2020.
How will claims reprocess?
Claims submitted with procedure code 87637 and modifier QW with dates of service on or after Oct. 6, 2020, will be automatically reprocessed for appropriate payment no later than Oct. 6, 2021. Providers may receive an additional payment.
Reminder
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).
Note
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 website for additional information regarding CLIA-waived tests, provider certifications and billing requirements.
Visit MLN Matters Number: MM12318 for additional information regarding QW Modifier for procedure code 87637.
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.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
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