Date Issued: 5/3/2019
EmblemHealth has been implementing payment policies that reflect guidelines set forth by industry authorities. Our goal is to process claims consistently and in accordance with best practice standards.
EmblemHealth has instituted additional payment policies for Clinical Laboratory Improvement Amendment (CLIA) waived tests.
CLIA waived tests are determined by the Food and Drug Administration (FDA) or Centers for Disease Control and Prevention (CDC) to be simple enough that there is little risk of error.
According to CMS policy, modifier QW (CLIA waived test) can only be appended to procedures designated as CLIA waived tests on the clinical laboratory fee schedule.
https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Downloads/waivetbl.pdf