2022 Coding Reference

For questions, please contact CodeMap Reimbursement Support at (312) 291-8408
or email quidel@codemap.com

Rapid & Molecular Reimbursement Summary

Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes

No payment adjustment through March 31, 2022
1% payment adjustment April 1 - June 30, 2022
2% payment adjustment beginning July 1, 2022

Rapid Diagnostics

Molecular Diagnostics

Cell Culture & Fluorescent Tests


Please select a product from one of the above categories.

  For Medicare Clinical Laboratory Fee Schedule, go to www.cms.hhs.gov.

*QW modifier is added to report use of CLIA-waived test system(s) for Medicare/Medicaid claims.

CMS has set the effective date for the addition of the QW modifier with 87420 and 87430 as October 6, 2020 and an implementation date of July 6, 2021. That means Medicare/Medicaid have until July 6, 2021 to update their systems to accept the QW modifier with these codes. We recommend customers check with their payers prior to submitting claims to verify if their system has been updated.

Effective January 1, 2010, CPT 81025 DOES NOT require a QW modifier to be recognized as a waived test. Source: CMS Job Aid 6685.

This information is being provided as a reference, for informational purposes only, with no expressed or implied warranty and does not purport to provide legal or certified coding advice. Under Federal and State law, it is the individual providerÕs responsibility to determine appropriate coding, charges and claims for a particular service. Policies regarding appropriate coding and payment levels can vary greatly from payer to payer and change over time. Quidel Corporation strongly recommends that providers contact their contracted payers to determine appropriate coding and charge or payment levels prior to submitting claims.

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CPT copyright 2021 American Medical Association. All rights reserved.

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08/14/2022 10:09:41