Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Texas MedicaidMedicaid · Billing Codes · General · TX · PathologyHigh impact

Updated CLIA Certifications and Claims Reprocessing for Certain Procedure Codes

Act
by Jun 30, 2026
Effective date
Jun 30, 2026
Identified
Jul 28, 2026

Summary

TMHP has updated CLIA laboratory certification requirements for 23 procedure codes, effective June 30, 2026. Beginning June 30, 2024, TMHP may reprocess historical claims (back to that date) for these codes, potentially resulting in additional payments or recoupments on future R&S reports. Your practice must ensure all laboratory service providers have current CLIA certifications submitted in PEMS.

Get alerts when payers change rules like this one

We check Texas Medicaid and other payers every day and email you when a change matches your specialty and state.

Get Texas Medicaid alertsPolicy Monitoring is free. No card required.

What to do

by Jun 30, 2026 · 6 steps
01Billing team must verify all laboratory service providers have submitted current CLIA certifications in PEMS matching the certification levels required for each affected code (certifications vary by code—see policy table).
02Update billing system to flag or validate that claims for these 23 codes originate from CLIA-certified labs with appropriate certification levels before submission.
03Accounting/revenue cycle team must monitor future R&S reports starting July 2024 for adjustments related to reprocessed claims (dates of service on/after June 30, 2024) and be prepared to post recoupments or additional payments.
04If your practice operates or bills laboratory services, submit all CLIA certifications to PEMS immediately via the Provider Enrollment and Management System.
05Failure to maintain CLIA certifications will result in claim denials for these procedure codes.
06Contact TMHP at 800-925-9126 (or 800-568-2413 for CSHCN) with questions.

Codes mentioned

782677826881050830138301483037839878752387900882408824188720887388874088741P2031

Original notice

Updated CLIA Certifications and Claims Reprocessing for Certain Procedure Codes
tmhp.com · Always check the source before changing claims.
View original ↗

Related changes

See all Texas Medicaid changes →
New TMHP CLIA Laboratory Certification Web Page Now AvailableHighNo effective date · GeneralBrowse every Texas Medicaid change in the policy list

Related policy hubs

Texas Medicaid policiesTX policy changesPathologyCode 78267Code 78268Code 81050Code 83013Code 83014Code 83037Code 83987Code 87523Code 87900Code 88240Code 88241Code 88720Code 88738Code 88740Code 88741Code P2031

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account