Approved In-Office Lab List

Date: July 16, 2025

Attention: All Providers

Reminder: This communication is to serve as a reminder of the 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, 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. The prior authorization form is available here.

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/clia/docs/tests-granted-waived-status-under-clia.pdf.

CLIA-Waived Tests

CPT	Modifier	Test Description
80061	QW	Lipid Panel
81002		Urinalysis Dip Stick/Tablet Rgnt Non-Auto w/o Micrscp
81003	QW	Urinalysis w/o Microscopy, Automated
81007	QW	Urine Screen for Bacteria
81025		Urine Pregnancy Test Visual Color Comparison Methods
82044	QW	Urine Dipstick for Micro-Albumin
82120	QW	Amines Vaginal Fluid Qualitative
82270		Blood Occult Peroxidase Actv Qual Feces 1 Deter
82271	QW	Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; other sources
82272		Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening
82465	QW	Cholesterol Serum/Whole Blood Total
82947	QW	Glucose Quantitative Blood Xcpt Reagent Strip
82950	QW	Glucose Post Glucose Dose
82962		Glucose, blood sugar by glucometer
83026		Hemoglobin; by copper sulfate method, non-automated
83036	QW	Hemoglobin; glycosylated (A1C)
83037	QW	Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use
83655	QW	Lead screening
84450	QW	Transferase Aspartate Amino AST SGOT
84460	QW	Transferase Alanine Amino ALT SGPT
84703	QW	Chorionic Gonadotropin Assay
85013		Spun Hematocrit
85014	QW	Blood Count Hematocrit
85018	QW	Blood Count Hemoglobin
85610	QW	Prothrombin Time
85651		Sedimentation Rate
86308	QW	Heterophile Antibodies Screen
87210	QW	Smr Prim Src Wet Mount NfctAgt
87804	QW	Influenza
87807	QW	Respiratory Syncytial Virus- Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus
87880	QW	Streptococcus Group A

Resources:

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