In this episode of the NP Business Matters podcast, I discuss the most misconceptions and frequently asked questions about CLIA Waivers.
A CLIA (Clinical Laboratory Improvement Amendments) Waiver simply allows you to do point of care (POC) testing in your practice. That POC testing must be done with tests that have received the designation of being CLIA Waived.
A CLIA Waiver has nothing to do with drawing blood or collecting specimens to send to the lab. It has nothing to do with administering vaccines, medication or other procedures in your office.
Listen in as I talk about:
- Which test are CLIA Waived
- How to obtain a CLIA Waiver
- Looking up CPT codes for waived tests
- Finding reimbursement on tests
- Obtaining waived test and more.
Make sure you listen in to the podcast for the details and then click the links below to get access to the resources.
- CMS CLIA How to Obtain Waiver
- CMS CLIA Waiver Regulations
- CDC CLIA
- CLIA Waived Test and CPT Codes (current as of May 2020) (this is a pdf download from WA State DOH. Your state website will have something similar, but they are uniform.
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I look forward to hearing your thoughts and questions about this episode in the comments below.
If I am collecting blood, urine samples and send to lab. can I bill to Medicare and insurances? Thank you. Gina
I’ve looked into getting a waiver. The problem in my office-psychiatric only, is that insurance companies pay so little that it would cost me more money to have a CLIA waiver than to get the same tests performed at a lab. It’s best for larger offices, not smaller practices.
Every practice is different and needs to make that call. Like anything you do in practice, you always want to look at the cost vs benefit – to the practice, to the patient and to yourself. Many small practices to fine with this, but again, it’s not for everyone.
There are CPT codes for collecting specimens, and often the collection is bundled into the visit. This will vary from payer to payer and you would need to query them to see if they reimburse.
When starting your practice how do you determine which POC test and manufacturers to list for waived testing? Is this easily updated as you need to add more tests.
CLIA Waivers expire in 2 years, I always updated at that time. You can also contact your state agency (I added a link to the bottom of the article) for any guidance in your location.