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1Providers operating under a CLIA waiver should use the QW modifier when appropriate.
2CCI, Correct Coding Initiative edits; NCD, National Coverage Determination; LCD, Local Coverage Determination.
3Centers for Medicare and Medicaid Clinical Diagnostic Laboratory Fee Schedule 2011, available at www.cms.hhs.gov/ClinicalLabFeeSched/02_clinlab.asp.
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It is the individual provider's responsibility to determine appropriate, medically necessary coding, charges and claims for a particular service. Providers are responsible for determining medical necessity for all Medicare recognized panel tests. To be eligible for coverage, each component test must be medically necessary for the individual patient. In addition, for tests grouped on single cassettes or cartridges, providers are responsible for determining the medical necessity of each test for each patient. Laws, regulations and payer policies regarding appropriate coding and payment levels can vary greatly from payer to payer and change over time. CLIAwaived.com recommends that providers contact their own regional payers to determine appropriate coding and charge or payment levels.
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