How to Report COVID-19 Laboratory Data
Summary of Recent Changes
- Effective May 11, 2023, HHS announced the Public Health Emergency declaration for COVID-19 has ended. In addition, HHS and CLIA regulatory requirements under the CARES Act Authority requiring reporting of laboratory test data to the federal government has also ended. State-specific reporting requirements may still apply. Laboratories and testing sites should review state-specific reporting requirements for COVID-19 testing. They may be required to continue reporting for COVID-19 testing to their State Health Departments.
Who can report
All COVID-19 testing sites must
- have a Clinical Laboratory Improvement Amendments (CLIA) certificate,
- meet all requirements to perform testing, including only using FDA-authorized test systems according to their instructions for use, and
- follow all state specific-reporting requirements for COVID-19 test results.
COVID-19 testing sites are defined as
- laboratories that perform clinical diagnostic or screening testing under CLIA,
- non-laboratory COVID-19 diagnostic or screening testing locations, and
- other facilities or locations offering COVID-19 point-of-care diagnostic or screening tests, or in-home diagnostic or screening tests.
CMS-certified long-term care facilities may submit point-of-care SARS-CoV-2 testing data, including antigen testing data, to CDC’s National Healthcare Safety Network (NHSN). This CDC- and CMS-preferred pathway to submit data to CDC’s NHSN applies only to CMS-certified long-term care facilities. Test data submitted to NHSN will be reported to appropriate state and local health departments using standard electronic laboratory messages. Other types of LTC facilities may also report testing data in NHSN for self-tracking or to fulfill state or local reporting requirements, if any.
Testing sites that perform COVID-19 surveillance testing on de-identified samples, regardless of their CLIA status, should not report the results of their surveillance testing to state, tribal, local, and territorial public health departments. If at any time a facility intends to report a patient-specific test result, it must first obtain a CLIA certificate and meet all requirements to perform testing. For more information, see the Center for Medicare and Medicaid Service’s (CMS) Research Testing and Clinical Laboratory Improvement Amendments of 1988 (CLIA) Regulations.
NOTE regarding self-test results: While there are no current mechanisms that require reporting of self-test results to public health authorities, CDC encourages everyone who uses a self-test to report any positive results to their healthcare provider. Healthcare providers can ensure that those who have tested positive for COVID-19 receive the most appropriate medical care, including specific treatments if necessary. COVID-19 home tests can be safely and privately reported at MakeMyTestCount.org.
Association of Public Health Laboratories (APHL), in collaboration with the Council of State and Territorial Epidemiologists (CSTE), CDC, and other public and private partners, has developed these CSTE tools to assist laboratories with reporting.
How to report
Laboratory data elements may be reported in the following ways:
- Submit laboratory testing data directly to state or local public health departments according to state/or local law or policy. Data must be sent using existing reporting channels to ensure rapid initiation of case investigations, and concurrent reporting of results must be shared with the ordering provider or patient, as applicable.
- Submit laboratory testing data to state and local public health departments through a centralized platform, where the data will then be routed to the appropriate state and local authorities and may be routed to CDC after removal of personally identifiable information according to applicable rules and regulations.
- Submit laboratory testing data through a state or regional Health Information Exchange (HIE) to the appropriate state or local public health department.
- CMS-certified long-term care facilities may submit point-of-care SARS-CoV-2 testing data, including antigen testing data, to CDC’s National Healthcare Safety Network (NHSN). This CDC- and CMS-preferred pathway to submit data to CDC’s NHSN applies only to CMS-certified long-term care facilities. Test data submitted to NHSN will be reported to appropriate state and local health departments using standard electronic laboratory messages. Other types of LTC facilities may also report testing data in NHSN for self-tracking or to fulfill state or local reporting requirements, if any.
What to report
Laboratories should make every reasonable effort to provide the following data elements when reporting to state and jurisdictional health departments.
- Test ordered – use harmonized LOINC codes provided by CDC
- Device Identifier
- Test result–use appropriate LOINC and SNOMED codes, as defined by the Laboratory In Vitro Diagnostics (LIVD) Test Code Mapping for SARS-CoV-2 Tests provided by CDC
- Test Result date (date format)
- Accession # / Specimen ID
- Patient age
- Patient race
- Patient ethnicity
- Patient sex
- Patient residence zip code
- Patient residence county
- Ordering provider name and nonpharmaceutical interventions (as applicable)
- Ordering provider zip code
- Performing facility name and CLIA number
- Performing facility zip code
- Specimen Source – use appropriate LOINC, SNOMED-CT, or SPM4 codes, or equivalently detailed alternative codes
- Date test ordered (date format)
- Date specimen collected (date format)
The following additional demographic data elements should also be collected and reported to state or local public health departments.
- Patient name (Last name, First name, Middle Initial)
- Patient street address
- Patient phone number with area code
- Patient date of birth
- Ordering provider address
- Ordering provider phone number
To protect patient privacy, any data that state and jurisdictional health departments send to CDC will be deidentified and will not include some patient-level information. The deidentified data shared with CDC will contribute to understanding COVID-19’s impact, case rate positivity trends, testing coverage, and will help identify supply chain issues for reagents and other materials.
CDC has posted a LOINC In-Vitro Diagnostic (LIVD) Test Code Mapping Guide for COVID-19 test results for tests with emergency use authorization from the U.S. Food and Drug Administration (FDA) that can be used by clinical laboratories and instrument manufacturers. This specification supports the use of standardized LOINC and SNOMED Clinical Terms (CT) codes to improve the accuracy of reporting tests for the SARS-CoV-2 virus. Using these harmonized LOINC and SNOMED-CT codes helps ensure that the same type of test is represented uniformly across the United States.
For those COVID-19 tests that have not yet received FDA emergency use authorization, CDC encourages test developers and laboratories that use COVID-19 tests to work together to obtain appropriate and interoperable LOINC and SNOMED-CT codes for reporting purposes.
LOINC codes must be used to represent the “question” a test asks of a specimen (e.g., does this specimen have SARS-CoV-2 RNA?), and SNOMED-CT codes must be used to represent the diagnostic “answer” (e.g., what was detected?). More background on these terminology standards can be found here:
Whenever possible, laboratories must use standard codes that already exist. Before requesting a new code, search the list of currently available LOINC codes for COVID-19 tests. If a LOINC test code cannot be identified whose attributes appropriately match the test for which coding is needed, new terms can be submitted, and a new code can be requested through LOINC.
Electronic reporting options are available to reduce the burden on providers reporting test results. Laboratories that are not currently reporting electronically to their state or local health department and want assistance in establishing electronic reporting can contact EDX@cdc.gov.
Below is a list of COVID-19 resources for laboratories:
- COVID-19 Information for Laboratories
- CDC’s Laboratory Outreach Communication System (LOCS)
- Clinical Laboratory COVID-19 Response Calls
Technical Implementation Resources
- Guidance for Encoding School Information for COVID-19 Public Health Reporting
- LOINC In Vitro Diagnostic (LIVD) Test Code Mapping for SARS-CoV-2 Tests
- COVID-19 Response | CSTE EMERGENCY PREPAREDNESS & RESPONSE
- Interoperability Standards Advisory for COVID-19 Pandemic
Data reporting information
No, facilities that conduct tests for individuals from multiple states must report results to the appropriate state or local health department based on the patient’s residence. If the patient’s address isn’t available, results should be reported based on the provider’s location.
Facilities that conduct tests for individuals who are temporarily living away from their permanent residence, such as students in college or active duty military personnel, should report to the state health department based on the individual’s temporary address near their college campus or military installation.
COVID-19 home tests can be safely and privately reported at MakeMyTestCount.org, but there is currently limited use for collecting self-test result data to inform public health surveillance. There are no current mechanisms that require reporting of self-test results to public health authorities. Voluntary reporting of self-test results will often be anonymous or lack data necessary for public health analysis or action. Therefore, the self-test results are unlikely to enhance understanding of trends in disease transmission or severity and often do not provide sufficient information to support case investigations. The public health community, including CDC, is confident that situational awareness remains strong without receiving self-test results. Find more information: About CDC COVID-19 Data.
Clinicians and laboratories should contact their state or local public health department directly for more information on reporting requirements and the method for reporting.
Yes, all data related to the AOE questions should be collected and reported to state and local public health departments in the electronic laboratory report messages.
Technical aspects of reporting
Yes, information about LOINC codes and the specific harmonized LOINC codes for COVID-19 tests can be found on CDC’s website: LOINC In Vitro Diagnostic (LIVD) Test Code Mapping for SARS-CoV-2 Tests.
CDC’s LOINC In Vitro Diagnostic (LIVD) Test Code Mapping for SARS-CoV-2 Tests website has a mapping catalogue coded for the data elements associated with COVID-19 tests, including the LOINC test order, LOINC test result, SNOMED-CT test description and SNOMED-CT specimen source. Test developers and manufacturers of new tests should contact DLSInquiries@cdc.gov for information about obtaining new codes.
The Association of Public Health Laboratories (APHL), in collaboration with the Council of State and Territorial Epidemiologists (CSTE), CDC, and other public and private partners, have developed the National ELR Flat File and HL7 Generator Tool to assist laboratories with reporting.
The DI for some tests can be found in the National Institute of Health’s (NIH) Access GUDID Database. For a specific DI not located in the Access GUDID Database, contact the device manufacturer to obtain the DI. If the manufacturer does not yet have the DI for the device you are using, contact DLSInquiries@cdc.gov for assistance.
Clinical research trial and study reporting
In general, no. Laboratories are not responsible for reporting these data. However, local, tribal, or state health department rules and regulations apply and may differ from this general guidance.
The reporting requirements differ for laboratories and clinicians:
Laboratories are not responsible for reporting these data since they do not have the patient-identifying information required to comply with reporting requirements. However, local, tribal, or state health department rules and regulations apply and may differ from this general guidance.
In clinical trials or other clinical studies, clinicians who are responsible for clinical care of trial or study participants are responsible for linking de-identified specimen test results to participant demographic information and may be required to report the results to the appropriate local, tribal, or state public health department based on the patient’s residence.
If a clinician receives test results related to COVID-19 from duplicate specimens that were collected in the same manner and tested with different test methods (e.g., different platforms) or in different CLIA-certified laboratories, the clinician should not report both results. In the case of two positive test results, the clinician should report the result that is provided first. In the case of discrepant test results, the clinician should report the positive result. However, local, tribal, or state health department rules and regulations apply and may differ from this general guidance.
If the clinician requests testing related to COVID-19 for study participants independent of research activities or for clinical management, results should be reported to the appropriate local, tribal, or state public health department.