Lab tests performed in provider offices

Participating providers will be reimbursed for laboratory tests they're certified to perform according to their Clinical Laboratory Improvement Amendments (CLIA) certification on file with the Centers for Medicare and Medicaid Services (CMS).

Participating labs

Refer any test you're not qualified to perform to a participating Joint Venture Hospital Lab in the East Region, or in West and North Michigan, participating hospital labs or Quest Diagnostics, Inc., as designated by the patient's primary care physician.

Go to guidelines for billing non-participating (reference) lab procedures.

Billing for CLIA labs

Providers must include the CLIA number that specifically represents the site where tests are performed.

All clinical diagnostic laboratories must include their CLIA numbers on all claims to avoid claim rejections.

To be recognized as a waived test, some CLIA waived tests have unique HCPCS procedure codes and some must have a QW modifier included with the HCPCS code. To view the CMS CLIA waived test list, refer to CMS Internet Only Manual (IOM), Publication 100-04, Chapter 16, Section 70.8.

CMS CLIA webpage :
CMS CLIA waived test list: