Clinical Laboratory

Improvement
Amendments
(CLIA)

How to Obtain a
CLIA Certificate
When is a CLIA Certificate
Required?
NOTE: Congress passed the Clinical Laboratory Improvement Amendments (CLIA)
in 1988 establishing quality standards for all laboratory testing to ensure the accuracy,
reliability and timeliness of patient test results regardless of where the test was
performed. The final CLIA regulations were published in the Federal Register on
February 28, 1992. The requirements are based on the complexity of the test and not
the type of laboratory where the testing is performed. On January 24, 2003, the
Centers for Disease Control and Prevention (CDC) and the Centers for Medicare &
Medicaid Services (CMS) published final CLIA Quality Systems laboratory
regulations that became effective April, 24, 2003.
 DO I NEED TO HAVE A CLIA CERTIFICATE?
CLIA requires all facilities that perform even one test, including waived
tests, on “materials derived from the human body for the purpose of
providing information for the diagnosis, prevention, or treatment of any
disease or impairment of, or the assessment of the health of, human
beings” to meet certain Federal requirements. If a facility performs tests
for these purposes, it is considered a laboratory under CLIA and must
apply and obtain a certificate from the CLIA program that corresponds
to the complexity of tests performed.

WHAT ARE THE DIFFERENT TYPES OF CLIA CERTIFICATES

AND HOW LONG ARE THEY EFFECTIVE?
All types of certificates are effective for two years and the different
types of certificates are:
l Certificate of Waiver (COW):

Issued to a laboratory that performs only waived tests.

l Certificate for Provider Performed Microscopy (PPM) procedures:

Issued to a laboratory in which a physician, midlevel practitioner

or dentist performs specific microscopy procedures during the
course of a patient’s visit. A limited list of microscopy procedures
is included under this certificate type and these are categorized as
moderate complexity.
l Certificate of Registration:

Issued to a laboratory to allow the laboratory to conduct nonwaived

(moderate and/or high complexity) testing until the laboratory is
surveyed (inspected) to determine its compliance with the CLIA
regulations. Only laboratories applying for a certificate of compliance
or a certificate of accreditation will receive a certificate of
registration.
l Certificate of Compliance (COC):

Issued to a laboratory once the State Department of Health conducts

a survey (inspection) and determines that the laboratory is compliant
with all applicable CLIA requirements. This type of certificate is
issued to a laboratory that performs nonwaived (moderate and/or high
complexity) testing.

1.
l Certificate of Accreditation (COA):
Issued to a laboratory on the basis of the laboratory’s accreditation
by an accreditation organization approved by CMS. This type of
certificate is issued to a laboratory that performs nonwaived
(moderate and/or high complexity) testing.
There are six CMS-approved accreditation organizations:
l AABB

l American Osteopathic Association (AOA)

l American Society of Histocompatibility and Immunogenetics (ASHI)

l COLA

l College of American Pathologists (CAP)

l Joint Commission on Accreditation of Healthcare Organizations

(JCAHO)

Contact information for the above CMS-approved accreditation

organizations is available on the CMS CLIA web site at
www.cms.hhs.gov/clia. If you apply for accreditation by one of the
CMS-approved accreditation organizations, you must also apply to
CMS for a COA concurrently.

WHAT IS A WAIVED TEST?

As defined by CLIA, waived tests are categorized as “simple
laboratory examinations and procedures that have an insignificant risk
of an erroneous result”. The Food and Drug Administration (FDA)
determines the criteria for tests being simple with a low risk of error
and approves manufacturer’s applications for test system waiver.

HOW CAN I FIND A LIST OF WAIVED TESTS?

For a list of waived tests sorted by analyte name, visit the FDA website at
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfClia/analyteswaived.cfm

For a list of waived tests sorted by the test categorization date and by the
test system name, visit the FDA website at
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfClia/testswaived.cfm.

2.
 WHERE CAN I FIND INFORMATION ABOUT TESTS
CATEGORIZED AS NONWAIVED (I.E., MODERATE AND/OR
HIGH COMPLEXITY)?
To determine which tests are categorized as waived or nonwaived
(i.e., moderate or high complexity), refer to the lists of tests online at
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCLIA/search.cfm.
You may also contact the local survey agency at your State Health
Department for categorization information concerning tests that you
may be performing in your laboratory. A list of State Agency addresses,
phone numbers and contact persons is available online under the
heading State Survey Agencies (CLIA Contact List) at the CMS CLIA
website. If you do not have online access or have questions concerning
certification, you may contact the CMS CLIA Central Office at
410-786-3531 for the address and phone number of your local State
Agency.

HOW DO I APPLY FOR A CLIA CERTIFICATE?

The CLIA application (Form CMS-116) is available online at the CMS
CLIA website located at the end of this brochure. Forward your
completed application to the address of the local State Agency for the
State in which your laboratory is located. This information is available
online or you may contact the CMS CLIA Central Office.

IS THERE ANY TYPE OF LABORATORY TESTING THAT IS

NOT SUBJECT TO A CLIA CERTIFICATE?
Yes, there are some testing exceptions that do not require CLIA
certification.
The following exceptions to CLIA certification apply regardless of a
laboratory’s location:
l Any laboratory that only performs testing for forensic purposes;

l Research laboratories that test human specimens but do not report

patient specific results for the diagnosis, prevention or treatment of

any disease or impairment of, or the assessment of the health of,
individual patients; or

3.
l Laboratories certified by the Substance Abuse and Mental Health
Services Administration (SAMHSA), in which drug testing is
performed that meets SAMHSA guidelines and regulations. However,
a CLIA certificate is needed for all other testing conducted by a
SAMHSA-certified laboratory.

ARE THERE ANY STATES THAT EXEMPT ME FROM

HAVING TO APPLY FOR A CLIA CERTIFICATE?
Any laboratory located in a state that has a CMS approved laboratory
program is exempt from CLIA certification. Currently, there are two
states with approved programs: Washington and New York. New York
has a partial exemption; therefore, if your laboratory is located in that
state, contact the New York State Agency concerning your need for a
CLIA certificate.

IF I HAVE MORE THAN ONE LABORATORY LOCATION, DO

I NEED A CLIA CERTIFICATE FOR EACH LOCATION?
You will need a CLIA certificate for each location where you perform
testing unless you qualify for one of the exceptions listed below.
l Laboratories that are not at a fixed location; that is, laboratories that
move from testing site to testing site, such as mobile units providing
laboratory testing, health screening fairs, or other temporary testing
locations may be covered under the certificate of the designated
primary site or home base, using its address.
l Not-for-profit or Federal, State or local government laboratories that

engage in limited public health testing, may file a single application.

l Laboratories within a hospital that are located at contiguous buildings

on the same campus and under common direction may file a single
application for the laboratory sites within the same physical location
or street address.
Contact your State Agency if you have questions or you are filing a
single application for more than one testing site.

4.
 WHAT KIND OF FEES DO I HAVE TO PAY TO CMS
FOR A CLIA CERTIFICATE?
If you apply for COW or a PPM certificate, you will pay a minimal
certificate fee every two years. There are no registration or compliance
fees.
If you apply for a COC, you will pay a one time minimal registration
fee that covers the cost of the CLIA enrollment in addition to a
compliance fee that covers the cost of the initial inspection by the State
Agency. CMS will send you a Certificate of Registration. Once
compliance has been determined by your inspection, you will pay a
certificate fee to CMS and CMS will send you a COC. A two-year
certificate cycle is then established, and you will pay a certificate fee
and a compliance fee every two years. CMS will send you a COC as
long as your laboratory is in compliance.
If you apply for a COA, you will pay a minimal registration fee that
covers the cost of the CLIA enrollment. Once CMS receives verifica-
tion from the accreditation organization that you have selected, you will
pay a certificate fee and validation fee to CMS and CMS will send you
a COA. A two year certificate cycle is then established and you will pay
a certificate fee and a validation fee every two years. CMS will send
you a COA as long as your laboratory remains compliant. You will pay
survey and any other fees to the accreditation organization.
You can obtain more information concerning the amount of certificate
fees from the CMS CLIA website under “CLIA Certificate Fee
Schedule” or from your State Agency. For information concerning
compliance (survey) fees, you may contact your State Agency or
accreditation organization. These fees are based on the number and
types of testing you perform and must cover the cost of the CLIA
program because CLIA is entirely user fee funded.

WILL I RECEIVE AN IDENTIFYING CLIA NUMBER?

You will receive a ten-digit number on the CLIA certificate. This
number will be utilized to identify and track your laboratory throughout
its entire history. You should use this number when making inquiries to
the State Agency and CMS about your laboratory.
5.
 WHEN CAN I BEGIN TESTING?
After you apply for your certificate, you will receive a coupon
notifying you of the corresponding fee. Follow the instructions on the
fee coupon for payment. After CMS receives your payment, your
certificate will be mailed to you. You may begin testing once you have
received your certificate containing your CLIA number. However, you
need to check with your State Agency since some states have
additional requirements.

WILL MY LABORATORY RECEIVE A CMS SURVEY?

Laboratories that have a COW or PPM certificate are not subject to
routine surveys. However, CMS is currently conducting a project
whereby a small percentage of laboratories that perform only waived
testing may receive an educational visit. These visits provide helpful
information to staff to help assure the quality of testing and have been
extremely well received.
If your laboratory performs any nonwaived testing, the laboratory may
have either a COC or COA. All laboratories with either of these
certificate types must meet all nonwaived testing requirements and are
subject to biennial surveys, by CMS or a CMS agent (such as a sur-
veyor from the State Agency) or by a CMS-approved accreditation
organization, if the laboratory is accredited. COA laboratories must
also meet the requirements of their accreditation organization.
Additionally, a limited percentage of laboratories with a COA will
receive a validation survey by CMS or a CMS agent. This is a survey
performed by CMS or a CMS agent to evaluate the results of the most
recent survey performed by an accreditation organization.
NOTE: If CMS or the State Agency receives a complaint against
your laboratory, you may receive an unannounced on site survey,
even though you only perform waived tests or PPM procedures.

6.
 IF I HAVE A CERTIFICATE FOR PPM PROCEDURES, A
CERTIFICATE OF REGISTRATION, A COA OR A COC,
CAN I ALSO PERFORM WAIVED TESTS?
Yes, these certificates permit laboratories to also perform waived tests.

IF I HAVE A COA OR A COC, CAN I ALSO PERFORM

PPM PROCEDURES?
Yes, these certificates permit laboratories to perform PPM procedures
as well as waived tests. The certificate you obtain should be for the
highest (most complex) category of testing you perform.

DO I NEED TO NOTIFY ANYONE IF I MAKE ANY CHANGES

IN MY LABORATORY?
For all types of CLIA certification, you must notify the State Agency
or your accreditation organization within 30 days of any changes in:
l Ownership

l Name

l Location

l Director

l Technical supervisor (for high complexity testing only)

If you perform only waived tests and wish to add PPM procedures or
other nonwaived (moderate or high complexity) testing to your menu,
you must reapply for the appropriate certificate using the same form
(Form CMS-116) you used for your initial CLIA certification.
However, you cannot begin nonwaived testing until you have paid the
appropriate fee, and have received the appropriate certificate.
If you perform PPM procedures and wish to add other nonwaived
(moderate or high complexity) testing, you must first apply for the
appropriate certificate.
If you have a COC or COA and wish to add tests categorized under
a different laboratory specialty or subspecialty than those on your
current certificate or that employ a different test method from those
you are already performing, you must notify the State Agency or the
accreditation organization of the new testing.
7.
 IF I HAVE ANY QUESTIONS ABOUT MY CERTIFICATE OR
CHANGES IN MY TEST MENU, WHO SHOULD I CONTACT?
You should contact the State Agency where your laboratory is located.
You can find this information as well as other information about CLIA
at www.cms.hhs.gov/clia or you may contact the CMS CLIA Central
Office at 410-786-3531.

WHERE CAN I FIND ADDITIONAL INFORMATION

AND GUIDANCE?
Refer to the “The State Operations Manual”, Appendix C – Interpretive
Guidelines (CMS Publication 7) available on the CMS website at:
www.cms.hhs.gov/clia.

Links to other laboratory-related resources can be found at these

websites:

CDC: www.phppo.cdc.gov/clia/default.asp
FDA: www.fda.gov/cdrh/CLIA/index.html

8.
NOTE: This brochure is not a legal document. The official CLIA program
provisions are contained in the relevant law, regulations and rulings.

Brochure #5
March 2006