DEPARTMENT OF HEALTH & HUMAN SERVICES 
                                                                                                   Health Care Financing Administration 
Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
 
April 7, 1998 
 
                                                                                                                                                                            Refer To  DEEO1: 
 
                                                                                                                                                                         :  
 
  MEDICAID CLINICAL LABORATORY  IMPROVEMENT 
  AMENDMENTS    (CLIA)    IMPLEMENTATION  
 
Dear State Medicaid Director: 
 
PLEASE CONVEY TO MEDICAID CLAIMS PROCESSORS IMMEDIATELY! 
 
 
In Medicaid CLIA Releases numbered 31 and 32 all Medicaid State Agencies (MSAs) 
were given the new CLIA MSA layout and instructions on the procedures to deny 
payments to laboratories submitting claims for services not covered by a CLIA 
certificate. This letter further clarifies instructions contained in CLIA releases and 
provides new procedures for implementing the CLIA program. 
 
To provide States with the necessary data on a timely basis in order to operate the 
Medicaid program more efficiently, the Health Care Financing Administration (HOFA) 
has started using the Internet as a means to distribute pricing files. Initially, the files 
that can be accessed are: 
 
1. the Clinical Lab Fee Schedule; 
2. the Durable Medical Equipment, Prosthetics/Orthotics, and Supplies (DMEPOS) 
Fee Schedule; and, 
3. the National Physician Fee Schedule Relative Value File. 
 
All of these are listed under the heading Payment Rates  Non Institutional Providers 
-- 
on the Internet at: "http://www.hcfa.gov/stats/pufiles.htm" and were listed under 
Medicare. 
 
Whenever updates are made to a file, the current Internet file is replaced. Providing 
the files on the Internet has met with such a positive response that HCFA   
Page 2 State Medicaid Director 
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has decided to create and maintain a set of Medicaid CLIA related files, on the 
Internet, to support the CLIA initiative. In addition to the three previously mentioned 
files, other files to be placed on the Internet include the most up-to-date lists of 
waived tests, Provider-performed Microscopy Procedure (PPMP) tests, and a file that 
includes all tests that are subject to CLIA edits. A copy of the most recent Medicaid 
CLIA Releases numbered 31 and 32, as well as this one, will also be placed on the 
Internet. We invite you to advise us of any other files that could be placed on the 
Internet that would be useful to MSAs in support of the CLIA program. 
 
MSAs are advised to access the Internet on a regular basis to determine if any of the 
files have been updated. The fee schedule files are usually updated in November or 
December. The waiver, PPMP, and tests required under CLIA edits are subject to 
change at any time. CLIA Releases are sent out as needed. Fewer CLIA Releases 
will be needed in the future since data files will be maintained on the Internet. 
 
The address for the Medicaid CLIA data files on the Internet is at: 
"http://www.hcfa.gov/medicaid/clia/cliahmpg.htm". 
 
The waived and PPMP tests were recently revised therefore it would be advisable for 
MSAs to access the Internet and review and/or print these two files. When "Pending" 
is used on the Current Procedural Terminology (CPT) code waived list it signifies that 
until we receive all necessary information from the manufacturer, we are unable to 
determine the correct CPT code to use. We use the word "Pending" so that we are 
able to at least update the list with the name of the waived test and we will insert the 
CPT code once all information is received and the correct CPT code is determined. 
When an effective date is used it means that this code was effective in the Medicare 
Common Working File (CWF) as a waived test code as of that date. For service 
dates prior to that date, labs should use the appropriate HCFA Common Procedure 
Coding System (HOPOS) code noted in parentheses under the USE column. 
 
Comments or questions may be directed to Medford J. Campbell, Jr. at 
(410) 786-4457. 
 
 
                                                        /s/ 
 
Sally K. Richardson 
                                                    Director 
Center for Medicaid and State Operations 
  Page 3 State Medicaid Director 
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cc: 
All HCFA Regional Administrators 
 
All HOFA Associate Regional Administrators for Medicaid and State Operations 
 
Lee Partridge 
American Public Welfare Association 
 
Joy Wilson 
National Conference of State Legislatures 
 
Jennifer Baxendell 
National Governors' Association