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Updates and Claims Reprocessing for Some CLIA Laboratory Codes

Last updated on 12/15/2021

TMHP has updated some laboratory procedure codes to comply with Clinical Laboratory Improvement Amendment (CLIA) guidelines and to align with the Centers for Medicare & Medicaid Services.

Effective for dates of service on or after April 1, 2008, the following Medicaid laboratory procedure codes will be subject to CLIA edits:

Procedure Codes

78267

78268

         

Claims submitted with these procedure codes for dates of service from December 30, 2019, through December 30, 2021, may be reprocessed. Affected claims may result in an additional payment or recoupment, which will be reflected on future Remittance and Status (R&S) reports.

Effective for dates of service on or after February 1, 2000, the following Children with Special Health Care Needs (CSHCN) Services Program laboratory procedure codes will be subject to CLIA edits:

Procedure Codes

78267

78268

         

Claims submitted with these procedure codes for dates of service from December 30, 2019, through December 30, 2021, may be reprocessed. Affected claims may result in an additional payment or recoupment, which will be reflected on future Remittance and Status (R&S) reports.

Effective for dates of service on or after January 1, 2021, the following laboratory procedure codes will be subject to CLIA edits:

Procedure Codes

80143

80151

80161

80167

80179

80181

80189

80193

80204

80210

82077

82681

   

Claims submitted with these procedure codes for dates of service from January 1, 2021, through December 30, 2021, may be reprocessed. Affected claims may result in an additional payment or recoupment, which will be reflected on future Remittance and Status (R&S) reports.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.