TMPPM 2011 > Radiology and Laboratory Services Handbook > Independent Laboratory > Services, Benefits, Limitations and Prior Authorization > CLIA Certificates

2.2.1 CLIA Certificates

Providers that hold full, accredited certifications (i.e., CLIA 1, 3, or 9) may be reimbursed for any laboratory procedure.

Providers that hold waiver CLIA certificates (i.e., CLIA 2) may be reimbursed for the following tests:

Claims submitted with any of the procedure codes specified in the above table may be reimbursed if they are submitted with modifier QW. Modifier QW is required by CLIA for specific codes based on their complexity. Claims will be denied if modifier QW is not included.

Providers that hold Physician-Performed Mictoscopy Procedure (PPMP) CLIA certifications (i.e., CLIA 4) may be reimbursed for the waiver certificate procedure codes in the above table and for the following tests:

Medicaid bills must accurately reflect those services authorized by the CLIA program and no other procedures.

Providers who have no CLIA certification on file with TMHP may be reimbursed for the following tests: