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Updated CLIA Certifications and Claims Reprocessing for Certain Procedure Codes

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The Texas Medicaid & Healthcare Partnership (TMHP) has updated certain procedure codes to comply with Clinical Laboratory Improvement Amendment (CLIA) requirements and to align with the Centers for Medicare & Medicaid Services (CMS) guidelines.

Beginning June 30, 2026, the following procedure codes have additional CLIA laboratory certifications:

Procedure CodeType of ServiceLaboratory CertificationsEffective Date
0019M5140, 310, 320, 61010/1/2023
0061U5310, 320, 610, 6307/1/2018
0106U5310, 610, 6301/1/2020
0156U1220, 310, 320, 9001/1/2020
0254U5220, 310, 320, 9007/1/2021
0294U5220, 310, 320, 9001/1/2022
782675110, 310, 3201/1/2000
782685110, 310, 3201/1/2000
810505110, 310, 3201/1/1983
830135110, 310, 3201/1/2011
830145110, 310, 3201/1/2005
830375310, 320, 3301/1/2006
839875310, 320, 610, 6301/1/2010
875235310, 330, 9001/1/2024
879005310, 330, 9001/1/2006
882405310, 330, 9003/1/1963
882415310, 330, 9003/1/1963
887205140, 310, 4001/1/2009
887385310, 340, 4001/1/2010
887405310, 340, 4001/1/2009
887415310, 340, 4001/1/2009
P20315310, 340, 4003/1/1963

Note: The laboratory certifications are effective for each procedure code on and after the effective date listed in the table above.

Claims Reprocessing

TMHP may reprocess claims that were submitted with these procedure codes for dates of service on or after June 30, 2024. If there are any additional payments or recoupment, they will appear on future Remittance and Status (R&S) reports.

Reminder: All laboratory services providers must comply with CLIA rules and regulations. Providers may use the Provider Enrollment and Management System (PEMS) to submit their CLIA certifications.

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