Adjudication of Laboratory Tests that are Excluded from Clinical Laboratory Improvement Amendment (CLIA) Edits

CR 7325 instructs Medicare contractors to remove from CLIA editing all laboratory tests (and/or their components) that are included on the list of HCPCS codes in the 80000 series that are excluded from CLIA editing. You may request contractors to reprocess any claim for services included on the aforementioned list that was previously denied for lack of a CLIA number. For a list of the specific HCPCS codes subject to CLIA edits, refer to https://www.cms.hhs.gov/CLIA/downloads/Subject.to.CLIA.pdf on the CMS website. For a list of the specific HCPCS codes in the 80000 series that are excluded from CLIA edits, refer to https://www.cms.hhs.gov/CLIA/downloads/cpt4exc.pdf on the CMS website.