decisionhealth Newsletters, Coder Pink Sheets - 2005 Issue 4 (April)
The short story of CLIA coding
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Article Overview
This article explains the basics of CLIA as they relate to office laboratory testing and Medicare billing. It is intended for coding and billing professionals who need to understand how waived testing, certification status, claim form reporting, and recent CLIA-related test updates fit together. The article also notes a set of newly waived lab tests and a change affecting one CPT code for RSV testing, with references to CMS guidance and transmittals.
Why This Topic Matters
CLIA status affects whether laboratory claims are accepted and how office-based tests are reported. Understanding the article helps practices recognize when waived testing rules and related Medicare requirements apply, especially as new tests are added or coding guidance changes.
What You Will Learn
- The general role of CLIA in laboratory testing oversight
- How CLIA-waived testing relates to office lab certification
- Basic Medicare claim reporting considerations tied to waived tests
- Where to find CMS resources referenced for CLIA and claims guidance
- Which newly waived laboratory tests are mentioned in the article
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician office administrators
- Laboratory staff
Codes Discussed
Modifiers Discussed
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