tci Outpatient Facility Coding Alert - 2015 Issue 1
Reader's Question: CLIA Does Not Include 83009 and 86677
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Article Overview
This short Q&A article explains a CLIA-related lab billing question for a provider-facility setting. It discusses the general categories of laboratory test complexity, the role of Medicare’s CLIA-waived listings, and why certain lab tests may or may not qualify for the waiver indicator. It is aimed at coders, billing staff, and practices that perform in-office laboratory testing.
Why This Topic Matters
Laboratory reporting can differ based on CLIA status, so understanding whether a test appears on the waived list affects claim submission and reimbursement workflow for in-office labs.
What You Will Learn
- How CLIA categories relate to in-office laboratory testing
- How Medicare’s waived test listing affects laboratory reporting
- Why CLIA status matters for provider-facility lab billing
- Where to look for CLIA-waived test information
Who Should Read This
- Medical coders
- Billing staff
- Practice administrators
- In-office laboratory staff
- Primary care and outpatient practices
Codes Discussed
Modifiers Discussed
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