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NC Department of Health and Human Services
NC Division of
Medical Assistance

Laboratory Services

DMA Clinical Policy and Programs
Phone Number 919-855-4260
Fax 919-733-2796

A laboratory is any facility that performs laboratory testing on specimens derived from humans for the purpose of providing information for the diagnosis, prevention, or the treatment of or impairment of disease, or for the assessment of health.

An outside laboratory is a facility not directly associated with a particular clinic, hospital or individual practice.

Referral laboratory services are used by outside laboratories that do not have the means to test certain specimens.

Clinical Laboratory Improvement Amendments of 1988 (CLIA)

Under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), all laboratories that examine human specimens for the diagnosis, prevention, or treatment of any disease or impairment, or for assessment of the health of a human being must meet certain requirements to perform the examination.

Providers who have questions regarding CLIA certification should contact the Division of Health Service Regulation Acute and Home Care Licensure and Certification and CLIA Program at 919-855-4620.

Providers may also view information on the Centers for Medicare & Medicaid Services (CMS) website for CLIA and Categorization of Tests at


The National Correct Coding Initiative (NCCI) became operational with date of service March 31, 2011. Providers should review and adhere to NCCI for guidance on laboratory services at

Clinical Coverage Policies

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.

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