QW Modifier Update and Claims Reprocessing for Procedure Code 87521

Date: January 25, 2025

Attention: All Providers

Effective for dates of service on or after June 27, 2024

Call to action: The purpose of this communication is to information providers that effective for dates of service on or after June 27, 2024, procedure code 87521 (Infectious Agent Antigen Detection) will require the QW modifier. Claims submitted with procedure code 87521 for dates of service from June 27, 2024, through October 3, 2024, may be reprocessed.

How this impacts providers: The reprocessed claims may result in additional payment that will be reflected on future Remittance and Status (R&S) Reports.

Next step for Providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org

For access to all provider alerts: https://www.texaschildrenshealthplan.org/provideralerts