Clinical laboratory improvement amendments number – additional information

The purpose of this article is to provide additional information regarding submission of the Clinical Laboratory Improvement Amendments (CLIA) number on claims for laboratory services that include QW or 90 modifiers. As a reminder, claims filed without the CLIA number are considered incomplete and will reject.

 

Both paper and electronic claim formats accommodate the CLIA number.

• On the CMS-1500 form, box 23 (Prior Authorization) is reserved for the CLIA
• On the 837P, REF segments are available: REF (X4) in loops 2300 and 2400, and REF (F4) in loop 2400.

 

Note: The CLIA number for the referring clinical laboratory should be included in REF (F4).

 

The following examples illustrate how the CLIA number as well as procedure code modifiers QW and 90 should be filed.

Claim format		Location(s) reserved for procedure modifier and CLIA number
Modifier QW — diagnostic lab service is a CLIA waived test
CLIA waived tests — Simple laboratory examinations and procedures that have an insignificant risk of an erroneous result
CMS-1500		Procedure modifier QW: Box 24d	CLIA number: Box 23 Prior Authorization
837P		Procedure modifier QW: Loop 2400 SV101-3 (first position)	CLIA number: Loop 2300 or 2400 REF X4
Modifier 90 — Reference (outside) laboratory
Referring laboratory — refers a specimen to another laboratory for testing Reference laboratory — receives a specimen from another laboratory and performs one or more tests on that specimen
CMS-1500		Procedure modifier 90: Box 24d	CLIA number: Box 23 Prior Authorization
837P	Procedure modifier 90: Loop 2400 SV101-3 — SV101-6	CLIA number: Loop 2300 or 2400 REF X4		CLIA number — Referring facility identification: Loop 2400 REF F4

Additional information regarding CLIA is available on the CMS website at https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA. If you have additional questions, please call the telephone number on the back of the member’s identification card.