Why POCT matters now

Point-of-care testing (POCT) turns quick diagnostic checks into immediate clinical action: faster care for your patients, a clearer pathway to treatment, and a meaningful new revenue stream for independent pharmacies. With clear state guidance in 2024–2025 and evolving Medi-Cal rules, now is the moment for California pharmacy owners to evaluate POCT as a strategic service offering. 

1) What you must have before you start (checklist)

Short version: get your CLIA waiver, register with California, confirm scope-of-practice, and stand up SOPs and staff training.

• CLIA Certificate of Waiver — Required to perform CLIA-waived POCT. Complete Form CMS-116 to apply. 
• California registration (CDPH — Laboratory Field Services / LFS) — California implements CLIA via CDPH; pharmacies must register with CDPH in addition to the federal CLIA waiver. Keep your CDPH certificate current (fees apply). 
• Address match — The CLIA / California lab registration “service address” must match your pharmacy’s physical/service address — mismatch = billing or enrollment problems. (DHCS guidance requires matching addresses for Medi-Cal enrollment.) 
• Scope of practice — California law and recent bills make clear pharmacists can perform FDA-approved CLIA-waived tests when done within scope and per rules (see BPC §4052.4 and SB 409). Confirm your protocols align with these rules. 
• SOPs, quality control, staff training — Maintain device manufacturer instructions, QC logs, documentation, and infection control policies. A named POCT lead (pharmacist) should own training and documentation.

2) Which POCT services can a California pharmacy reasonably offer?

Most community pharmacies begin with high-demand CLIA-waived tests. Confirm each device/test is on the FDA/CDC CLIA-waived list before you buy or bill. 

Typical starting menu:

• Rapid influenza A/B (antigen) — CPT examples: 87804 (QW). 
• Rapid Group A Strep — CPT example: 87880 (QW). 
• Rapid COVID-19 antigen or NAAT (authorized) — CPT 87426 (antigen) / 87635 (POC molecular). 
• A1c (POC) — CPT 83037QW (POC version). 
• Lipid/cholesterol panels (waived devices where applicable). 
• Pregnancy (urine) — CPT 81025QW (waived urine tests). 

Note: QW modifiers and exact CPTs vary by device and payer; always verify the device’s waived status and payer rules before billing. 

3) Billing & reimbursement — what to know (practical)

Big picture: billing rules are evolving. Medi-Cal now allows pharmacy providers with a valid CLIA waiver + California lab registration to submit claims for CLIA-waived tests — but you must be properly enrolled and your paperwork must match. 

Steps to bill (high-level):

1. Enroll / update Medi-Cal: Submit supplemental enrollment that includes your CLIA Certificate of Waiver and California Clinical Laboratory Registration. Ensure addresses match. 
2. Choose the right CPT / HCPCS and modifiers: Use the CPT codes tied to the device/test (see CDC/CMS lists). Include the QW modifier for CLIA-waived tests where required.
3. Document fully: Attach test lot numbers, device used, staff who performed the test, consent, and results — essential for appeals and audits.
4. Expect variability: Commercial payers and Medi-Cal managed care plans may have different coverage and rates. Verify with each payer before relying on reimbursement.

Common codes (examples — confirm before use): 87804 (influenza antigen), 87880 (strep A), 87426/87635 (COVID antigen/molecular), 83037 (A1c POC). Use QW where required and check bundling rules (e.g., capillary collection 36416 often bundled).

4) How RxBB helps you operationalize POCT billing (practical RxBB workflow)

You already have clinical competency — RxBB helps you capture and collect revenue reliably. Key capabilities proven in shop pilots:

• Auto-generate billing codes per appointment/test (reduces manual error and speeds claims). 
• Link claim status to each billing code so you see approvals/denials by code in real time and know exactly which claims need appeals. 
• Attach clinical documentation (test results, lot numbers, patient consent) directly to claims for faster appeals. 
• Custom service types: build “POCT appointment” templates with pre-defined CPTs, patient flows, and pricing. 
• Reporting & profitability: dashboards that show test volumes, payer acceptance, denial reasons, and margins so you can decide which tests to scale. 

If you want to reduce follow-up time on denials and get paid faster, these features address the most common operational blockers independent pharmacies face.

5) Quick start playbook (first 30–60 days)

1. Audit: Compare your current inventory and devices to the FDA/CDC CLIA-waived list.
2. Apply: Submit CMS-116 and register with CDPH LFS (verify fees and timelines). 
3. Enroll: Update Medi-Cal/provider enrollment with CLIA & CA registration documents.
4. Train: Document SOPs, QC logs, and staff training signoffs.
5. Test billing: Run a small number of claims through RxBB (or your billing tool), track denials, and fix mapping errors. 
6. Market locally: Announce POCT to patients and prescribers (explain coverage and copays). 

6) Common pitfalls & how to avoid them

• Address mismatch (CLIA vs. Medi-Cal enrollment) → verify addresses on all certificates before billing. 
• Wrong CPT / missing QW modifier → check device-specific guidance (CDC/CMS) and payer rules before submitting. 
• Incomplete documentation → always attach lot numbers, consent, and device used for each claim.
• Supply/cold-chain issues → plan procurement and minimum order rules with vendors before launching.

The opportunity for independent pharmacies

POCT is a low-barrier, high-impact way to expand clinical services, deepen patient relationships, and recover margin outside of dispensing. In California, the pathway is clear if you: secure your CLIA waiver, register with CDPH, enroll correctly with Medi-Cal, and use operational tools (like RxBB) to manage codes, claims, and appeals efficiently.

Disclaimer

This article reflects RxBB’s current understanding of Medi-Cal POCT reimbursement and processes. It is not final guidance. Rules, rates, and workflows are still developing as Medi-Cal, CPhA, CPESN, and other agencies release updates. We strongly encourage pharmacies to:

• Verify details with Medi-Cal and managed care plans,
• Stay updated with official communications,
• Treat this information as a starting framework, not definitive policy.

How RxBB can help (short & direct)

RxBB provides pre-built POCT templates, automated code generation, and per-code claim tracking so you can start fast, bill accurately, and see payment status in real time. That means less time fixing denials, faster cash flow, and clearer data to decide which tests to scale — without adding administrative overhead.Ready to operationalize POCT without the billing headaches? Schedule a meeting with RxBB to see how automated coding, per-code claim tracking, and attachments for documentation can get you paid faster: Schedule Appointment Here.