Top 10 States by Non-Exempt CLIA Certificate of Accreditation Counts:2026

Texas leads with 2,535 laboratories in CMS’s CLIA Certificate of Accreditation category, followed by Florida with 1,306 and California with 1,223. Michigan and Minnesota tie for ninth with 437 each.

Use this ranking when the question specifically concerns the Certificate of Accreditation pathway. For a broader non-waived-testing product, include other relevant certificate categories before comparing territories. The Michigan–Minnesota example shows why equal Accreditation counts need not imply equal broader certificate populations.

Table of Contents

• The ten leading states
• What the certificate category means
• Worked comparison: equal counts, different shares
  • What happens if the product is not accreditation-specific?
• Build an accreditation cohort in QOPE
• Reconciliation and counting method
  • Scope and status limitations
• Sources

The ten leading states

Source: the Accreditation column in CMS’s September 2026 laboratory statistics, pages 3–4. The comparison retains the 50 states, excludes non-state areas, and includes non-exempt laboratories only.

These ten states account for 8,747 laboratories, or 57.05% of the 50-state total of 15,333 in this category.

Equal counts receive equal competition ranks. There is no sole tenth-place state: Michigan and Minnesota share ninth, and Virginia follows at rank 11 with 382. Alphabetical order within the tie does not indicate a stronger position.

What the certificate category means

The CMS-116 instructions describe the Certificate of Accreditation pathway through a CMS-approved accreditation organization. Under the applicable conditions, it permits waived, provider-performed microscopy, and moderate- or high-complexity testing. The category does not identify the complete testing menu of every laboratory.

Keep three classifications separate:

This ranking uses certificate type. It does not add Compliance, Waiver, or Provider Performed Microscopy counts, or select records merely because an organization indicator is present.

New York and Washington remain in the comparison, but their separately reported exempt-program laboratories are not added. Their non-exempt Accreditation counts therefore do not represent every accredited or state-regulated laboratory in those states.

Worked comparison: equal counts, different shares

Michigan and Minnesota illustrate two different territory questions. Both have 437 laboratories in the Accreditation category, but their broader non-exempt certificate populations differ:

The denominator combines Compliance, Waiver, Provider Performed Microscopy Procedures, and Accreditation. It does not use an exempt-and-non-exempt population or a QOPE record count.

If the question is how many laboratories appear in this certificate segment, the states tie. If the question is what share of the published non-exempt certificate population follows this pathway, Minnesota has the higher share. Neither answer establishes which state offers more qualified purchasing accounts.

What happens if the product is not accreditation-specific?

The same September report lists 255 Compliance laboratories in Michigan and 235 in Minnesota. Combining Compliance and Accreditation produces 692 in Michigan versus 672 in Minnesota—a 20-laboratory difference, despite the Accreditation tie.

Choose the population that fits the question before choosing a territory. Compliance and Accreditation have relevant non-waived-testing permissions under CMS conditions, but those permissions do not establish the actual testing menu or purchasing need.

Build an accreditation cohort in QOPE

Open QOPE Laboratories to investigate one state + the Certificate of Accreditation category + your target facility setting. For the worked comparison, repeat the same criteria for Michigan and Minnesota.

QOPE’s dataset catalog documents state, facility-type, certificate-type, and accreditation filters. It lists Laboratories as a premium dataset on Pro and Teams. Follow the documented table and export workflow:

1. Choose the State and verify which Certificate type value corresponds to CLIA Certificate of Accreditation. Add the relevant Facility type.
2. Record the dataset freshness timestamp, filter selections, and displayed row count.
3. Open Export, select CSV, and inspect the offered sample. Retain the available identifier, name, location, certificate-type, and facility-type columns needed for review.
4. Compare the download count with the filtered total. The documented export cap is 1,000 rows per file; a capped file may be incomplete.
5. For larger cohorts, use relevant narrower slices and document their coverage. Check gaps and overlaps before combining files or comparing states.

The deliverable is a candidate list for a defined certificate and facility segment. Mark records eligible when the requirements are supported, ineligible when a disqualifier is established, and unknown when evidence is insufficient. Record the evidence and review date, resolve repeated or conflicting IDs, and establish purchasing relationships before counting accounts. Report unreviewed records separately; a capped or selective review cannot establish a whole-state eligibility rate.

For a separate question about a particular accrediting organization, define an organization-based cohort explicitly. Do not substitute that cohort for the certificate-based ranking or sum multiple organization flags as separate laboratories.

Evidence boundary: these steps follow public documentation reviewed October 7, 2026, rather than a tested signed-in export. QOPE’s field mappings and population have not been reconciled to CMS. A dataset update timestamp alone does not establish the reporting date of every field.

Reconciliation and counting method

We retained the 50 state values from the Accreditation column, sorted them descending, and assigned equal competition ranks to equal counts. All 50 states have numerical values. No record-level deduplication was performed.

The state values total 15,333. The excluded areas—DC, American Samoa, Guam, Puerto Rico, Saipan, the Virgin Islands, and International—add 209, reconciling to CMS’s published 15,542 Accreditation total across all reported areas.

The report’s seven accrediting-organization counts separately sum to 15,397, which is 145 fewer than 15,542. CMS does not explain that gap in the report. It does not prove overlapping memberships or missing laboratories, and we make no adjustment to the state certificate counts.

The checks performed were:

These checks validate transcription and arithmetic, not each underlying laboratory. Use September figures consistently: substituting the August registered-laboratory ranking would change both period and population.

Scope and status limitations

This is a non-exempt certificate-category comparison, not a census of every accredited laboratory or a quality ranking. September 2026 is the report period, not an exact extraction day or real-time status check. CMS-116 permits qualifying multiple-location arrangements under one certificate, so registrations cannot establish buildings or purchasing accounts.

Sources

• CMS laboratory statistics, September 2026: pages 3–4 supply state certificate counts; page 1 supplies overall and organization totals.
• CMS-116 application and instructions, March 2024 revision: certificate permissions, facility classifications, and multiple-site provisions.
• QOPE dataset catalog, table guide, and export guide: documented access and workflow.

CMS may replace the report at the same URL. Retain the September 2026 PDF when reproducing this ranking.