Codes Subject to CLIA Edits in 2008: CMS Issues a List of Eight Codes

As you probably know, the CPT codes that CMS considers to be laboratory tests under CLIA, which require a certification, change each year.  In Transmittal 1471 (February 29), CMS informed Medicare carriers and Part A/B Medicare administrative contractors (MACS) about the 2008 codes that are subject to CLIA edits and also about those that are now excluded from CLIA edits.

Specifically, it notes that code 86586 (unlisted antigen, each) was discontinued on December 31, 2007. For 2008, the new HCPCS code 86486 (skin test; unlisted antigen, each) will be excluded from CLIA edits and does not require a facility to have any CLIA certificate.

The codes below are subject to CLIA edits. Note that the list does not include new codes for waived tests or provider-performed procedures. Facilities must either have a CLIA certificate of registration (certificate type code 9), a CLIA certificate of compliance (certificate type code 1), or a CLIA certificate of accreditation (certificate type code 3) to be paid for these tests. No Medicare payment will be made to facilities that do not have these certificates and, in fact, claims submitted for them will be denied.

80047 Basic metabolic panel (Calcium, ionized)
82610 Cystatin C
83993 Calprotectin, fecal
84704 Gonadotropin, chorionic (hCG); free beta chain
86356 Mononuclear cell antigen, quantitative (e.g., flow cytometry), not otherwise specified, each antigen
87500 Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (e.g,, enterococcus species van A, van B), amplified probe technique
87809 Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus
88381 Microdissection (i.e., sample preparation of microscopically identified target); manual
89322 Semen analysis; volume, count, motility, and differential using strict morphologic criteria (e.g., Kruger)
89331 Sperm evaluation, for retrograde ejaculation, urine (sperm concentration, motility, and morphology, as indicated)

To-Do List

Information Sources: Transmittal 1471 at; provider-information memo MM5926 at

Robin Miller Zwiefel, BS, MT (ASCP) is a Senior Healthcare Consultant with Medlearn. Robin brings a distinguished 16 years of clinical experience to her work.
Her services to clients include conducting CPT coding and chargemaster assessments; reviews of provider operations for regulatory compliance; and assisting in the implementation of facility compliance programs.