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24.1.1.1 Waiver and Physician-Performed Microscopy Procedure (PPMP) Certificates
CLIA certificates may limit the holder to performing only certain tests. Claims submitted to the CSHCN Services Program for laboratory services must accurately reflect those services authorized by CLIA and no other procedures. There are two types of certificates that limit holders to only certain test procedures: Waiver and PPMP certificates. Providers are responsible for practicing within the limits of their certificates and maintaining awareness of the most current information regarding enforcement of CLIA provisions. A list of those test procedures follows.
Procedures Payable to Providers with Waiver Certificates
Providers holding waiver CLIA certificates are authorized to perform only the following tests. The QW modifier is a CLIA requirement for these procedure codes based on their complexity (except as indicated below) and must be included or claims are denied. Only the following selected waiver tests are a CSHCN Services Program benefit.
Procedures Payable to Providers with PPMP Certificates
Holders of PPMP certificates are authorized to perform all the procedures listed for waiver certification in addition to the following tests:
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