CLIA Certification Types and Specialty and Subspecialty Codes
Date: April 30, 2026
Attention: Providers
Call to action: Texas Children’s Health Plan (TCHP) would like to provide clarity for the CLIA Certification Types and Specialty and Subspecialty Codes.
Source:
CLIA Certification Types are the following:
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TCHP’s claim system is equipped to link the type of CLIA certification and billable procedure codes to determine how the procedures will process, depending on CLIA waived status and the provider’s CLIA certification type.
Type of CLIA Certification Billable Procedure Codes
| Type of CLIA Certification | Billable Procedure Codes |
| Full/Accredited Certification | May bill any laboratory procedure, regardless of modifier that is required for other certification types |
| Waived Certification | May only bill CLIA-waived procedures (e.g., codes that do not require the QW modifier to be designated as CLIA waived tests, and procedures with the QW modifier) |
| PPMP (Partial) Certification | May only bill for Provider-Performed Microscopy Procedures, CLIA-waived procedures (e.g., codes that do not require the QW modifier to be designated as CLIA waived tests, and procedures with the QW modifier) |
| No CLIA Certification on file | May only bill procedures for which a CLIA certificate is not required |
CLIA Specialty and Subspecialty Codes
The full list of CLIA certification specialty type codes from CMS can be found in the following link: https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Downloads/lccodes.pdf.
Resources:
- Texas Medicaid Providers Manual (TMPPM), Radiology and Laboratory Services Handbook: 2.1.1 Clinical Laboratory Improvement Amendments (CLIA) and 2.1.2 CLIA Requirements.
- Previously published Provider Alert on this topic: https://www.texaschildrenshealthplan.org/news/provider-alert/clinical-laboratory-improvement-amendment-clia-requirements-related-pems
- Reminder: CLIA Certification Required for Laboratory Service Claims | Texas Children's Health Plan
Next steps: Providers are strongly advised to share this information with their staff and ensure CLIA certifications are current in PEMS. Guidance is available at www.tmhp.com/topics/provider-enrollment/pems/licenses .
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.