Make sure your office is compliant with the latest Texas HHS labolatory requirenment! Don’t lose revenue and stay compliant!

What is updated?

• All lab providers that are registered with Texas Medicaid must have CLIA certificate
• That certificate needs to be uploaded into the state’s Medicaid system (PEMS)

Reimbursement UHC–

• For dates of service between March 1 and May 31, 2026– will include the notice if the CLIA is missing or not reflected in PEMS
• For dates of service on or after June 1, 2026– claims will be denied if The information is not in PEMS
• QW modifier on the claim to prevent processing delays- if the provider is only certified to perform the  waived tests on CMS

Resources:

• https://www.cms.gov/medicare/quality/clinical-laboratory-improvement-amendments?redirect=/CLIA/10_Categorization_of_Tests.asp
• https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2026/2026-02-february/2_17_radiology_and_lab_srvs.pdf

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