Practice Management Alert

Question: I need some clarification on CLIA numbers and who needs them for billing. I-m billing for a new lab that draws and processes blood and then sends the samples out. Does this lab have to have a CLIA number since they do not participate with Medicare or Medicaid?

Texas Subscriber

Answer: First, if the lab you are billing for is not actually performing the lab work and you are not billing a code from the 80000 series of CPT codes, you do not need a clinical laboratory improvement amendments (CLIA) number. If your lab is just performing the draw and prepping it for an outside lab, you won't deal with CLIA numbers no matter whom you are billing.

How it works: If your facility performs laboratory tests on human specimens for diagnosis or treatment, you-re required by federal law to have a CLIA certificate. Medicare requires the CLIA certificate number on claims. You must renew your CLIA certificates every two years for as long as the facility is performing the testing. You also need to report any changes in ownership, location and testing type within 30 days of the change.

If you are going to bill laboratory codes from the 80000 series, you-ll need to check with each of your payers to determine which ones require you to have a CLIA number. You may find it easier to just include the CLIA number with every claim to be sure.