Updated CLIA Certifications and Claims Reprocessing for Certain Procedure Codes
Date: August 10, 2026
Attention: All Providers
Call to action: Texas Children's Health Plan (TCHP) would like to inform providers that The Texas Medicaid & Healthcare Partnership (TMHP) has updated certain procedure codes to comply with Clinical Laboratory Improvement Amendment (CLIA) requirements and to align with the Centers for Medicare & Medicaid Services (CMS) guidelines.
Beginning June 30, 2026, the following procedure codes have additional CLIA laboratory certifications:
| Procedure Code | Type of Service | Laboratory Certifications | Effective Date |
|---|---|---|---|
| 0019M | 5 | 140, 310, 320, 610 | 10/1/2023 |
| 0061U | 5 | 310, 320, 610, 630 | 7/1/2018 |
| 0106U | 5 | 310, 610, 630 | 1/1/2020 |
| 0156U | 1 | 220, 310, 320, 900 | 1/1/2020 |
| 0254U | 5 | 220, 310, 320, 900 | 7/1/2021 |
| 0294U | 5 | 220, 310, 320, 900 | 1/1/2022 |
| 78267 | 5 | 110, 310, 320 | 1/1/2000 |
| 78268 | 5 | 110, 310, 320 | 1/1/2000 |
| 81050 | 5 | 110, 310, 320 | 1/1/1983 |
| 83013 | 5 | 110, 310, 320 | 1/1/2011 |
| 83014 | 5 | 110, 310, 320 | 1/1/2005 |
| 83037 | 5 | 310, 320, 330 | 1/1/2006 |
| 83987 | 5 | 310, 320, 610, 630 | 1/1/2010 |
| 87523 | 5 | 310, 330, 900 | 1/1/2024 |
| 87900 | 5 | 310, 330, 900 | 1/1/2006 |
| 88240 | 5 | 310, 330, 900 | 3/1/1963 |
| 88241 | 5 | 310, 330, 900 | 3/1/1963 |
| 88720 | 5 | 140, 310, 400 | 1/1/2009 |
| 88738 | 5 | 310, 340, 400 | 1/1/2010 |
| 88740 | 5 | 310, 340, 400 | 1/1/2009 |
| 88741 | 5 | 310, 340, 400 | 1/1/2009 |
| P2031 | 5 | 310, 340, 400 | 3/1/1963 |
Note: The laboratory certifications are effective for each procedure code on and after the effective date listed in the table above.
Claims Reprocessing
TMHP may reprocess claims that were submitted with these procedure codes for dates of service on or after June 30, 2024. If there are any additional payments or recoupment, they will appear on future Remittance and Status (R&S) reports.
Reminder: All laboratory services providers must comply with CLIA rules and regulations. Providers may use the Provider Enrollment and Management System (PEMS) to submit their CLIA certifications.
Next step for providers: Providers should share this information with their staff.
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.