R13855CP: July 2026 Quarterly Update to the Clinical Laboratory Fee Schedule (CLFS) and ClinicalLaboratory Improvement Amendments (CLIA): Healthcare Common Procedure Coding System(HCPCS) Codes, Waived Tests, and Reasonable Charge Payments.

REQUIREMENTS: - By July 6, 2026 (implementation date): Billing team must update billing system to recognize CPT code 87638 (Infectious agent detection by nucleic acid; rubeola/measles virus) and all new HCPCS codes listed in the attached 'Q3 New Codes' table from the Quarter 3 2026 CLFS/CLIA update file. - Immediately after July 1, 2026: Apply CLIA edits to all new non-waived codes (marked 'N' in Column G). Ensure claims for these codes validate that the performing facility has a valid CLIA certificate (types 1, 3, or 9). Claims from facilities with only CLIA waivers or provider-performed microscopy certificates must include the QW modifier or will be denied. - Before July 1, 2026: Configure billing system to append the QW modifier to all new waived tests (marked 'Y' in Column G) to ensure recognition under CLIA waived test provisions. - Contractors only: Implement contractor pricing logic for all new Proprietary Laboratory Analysis (PLA) codes until CMS establishes national pricing through the annual CLFS payment determination process. Do not apply national rates prematurely. - Delete all codes listed in the 'Q3 Deleted Codes' table from the billing system with delete date July 1, 2026. Scrub encounter forms and templates to prevent accidental use of discontinued codes. - Consequences of inaction: Claims with new codes will be denied for invalid CLIA status. Claims with deleted codes will be rejected. Claims without required QW modifiers will fail CLIA validation edits.