Important Lab Reminders

Date: August 18, 2026

Attention: All Providers

Reminder: There are specific labs on Texas Children’s Health Plan’s (TCHP) pre-approved list that may be run in a network provider’s office.

What This Means for Providers

• Providers may perform certain point-of-care lab tests in their office and receive reimbursement from TCHP.
• All other lab tests should be referred to:
  • TCHP in-network labs, for a location near you, Find Location - finder or
  • State of Texas Laboratories (for state-required lab submissions, follow the guidelines available here).

Genetic Testing Requirements

• Prior authorization is required for all genetic testing, except:
  • Cystic Fibrosis Screening
  • Spinal Muscular Atrophy Screening
  • This applies even when testing is done by an in-network lab.
    • For Prior authorization requests: In-network providers should access Texas Children’s® Link, provider portalto complete the necessary steps.
    • Other providers should complete the Standard Prior Authorization Form and follow the guidance available here: Prior Authorization Information | Texas Children's Health Plan.
  • Genetic testing capabilities are available at Quest Diagnostics.
    • To find a location: https://www.questdiagnostics.com/locations/search
    • Health Professionals link to Quanum® Lab Services Manager

Lead Screening Requirements

• Reporting all blood lead levels is mandatory in Texas. For more information, visit Texas DSHS Lead Reporting.
• For initial blood lead screening using point-of-care testing, submit procedure code 83655.
  • This code can only be billed by a physician in an office setting (POS 11) when it is billed with modifier QW during a THSteps visit.
• Providers must have a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver.
• As it relates to FQHCs and RHCs, lead screening is part of the encounter rates and is not reimbursed separately.

Approved In-Office Labs

Providers may only perform the following pre-approved labs in their office and bill with the correct CPT code. To refer to the full list of CLIA waived tests, visit https://www.cdc.gov/lab-quality/php/waived-tests/index.html.

CLIA-Waived Tests

Resource:

• Texas Medicaid Provider Procedures Manual (TMPPM), Radiology and Laboratory Services Handbook, section 2.1.1.and Children Services Handbook, section 4.3.12.6.6.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.