Awareness : Newsletter Articles

Codes Subject to and Excluded From CLIA Edits

Effective date January 1, 2018

The Clinical Laboratory Improvement Amendments (CLIA) regulations require a facility to be appropriately certified for each test performed. To ensure that Medicare only pays for laboratory tests performed in certified facilities claims considered a CLIA laboratory test are currently edited at the CLIA-certificate level.

The HCPCS codes that are considered a laboratory test under CLIA change each year. Contractors need to be informed about the new HCPCS codes that are both subject to CLIA edits and excluded from CLIA edits. More information is available in MLN Matters® article MM10446