Top 10 States by CMS-Reported Registered CLIA Laboratories:2026

Texas leads with 29,264 registered laboratories, followed by Florida with 25,701 and California with 23,441. This ranking combines CMS’s August 2026 non-exempt certificate counts with separately reported exempt-program laboratories in New York and Washington.

Use these totals to identify territories for further research. Before choosing one, define the facility setting and certificate pathway relevant to the product: New York’s position changes with exemption scope, and California overtakes Florida under a narrower certificate definition.

Table of Contents

• The ten leading states
• How the totals were calculated
• Why New York moves from 20th to 4th
• Worked comparison: certificate scope changes the territory choice
  • Decide what would justify prioritizing a state
• Build a territory comparison in QOPE
• Reconciliation and interpretation limits
  • Comparing records or reporting periods
• Sources

The ten leading states

The table covers the 50 U.S. states only. DC, territories, and international entries are excluded. Each total is calculated from the components in CMS’s August 2026 CLIA statistics report, pages 1 and 3–5; CMS does not publish this combined state-ranking table directly.

The top ten account for 154,360 laboratories, or 51.74% of the calculated 50-state population of 298,319. This denominator is separate from CMS’s published national total. Washington is eleventh with 8,062; there are no ties across the 50 combined state totals.

How the totals were calculated

For every state, sum the four published non-exempt categories:

Compliance + Waiver + Provider Performed Microscopy Procedures + Accreditation.

Then add the separately reported exempt-program count for New York or Washington. No additional exempt count is added for other states.

Texas illustrates the non-exempt calculation:

936 + 24,052 + 1,749 + 2,527 = 29,264.

The calculation uses numerical entries for all 50 states, sorts their combined totals descending, and checks the cutoff. It aggregates published counts; it does not count source-file rows or deduplicate laboratory identifiers.

Why New York moves from 20th to 4th

Excluding separately reported exempt laboratories changes the population being compared. The effect is substantial for New York and Washington:

New York ranks 20th using only non-exempt counts, but 4th using the combined definition. New Jersey holds tenth place in the non-exempt-only ranking with 7,546, but falls outside this combined top ten.

For broad geographic coverage research, retain the separately reported exempt population. For a question specifically about non-exempt certificate categories, use that narrower population and label it accordingly. An exempt-program classification is also different from a Certificate of Waiver: the CMS report lists them separately.

Worked comparison: certificate scope changes the territory choice

The largest registered population is not automatically the largest relevant population for a product. Consider the three leading states under two certificate definitions:

These certificate counts are non-exempt. None of these three states receives an added exempt-program count in this calculation.

Florida leads California by 2,260 in the overall ranking; California leads Florida by 119 when restricted to Compliance and Accreditation. The certificate definition reverses the ordering between these two states.

For a waived-testing product, Waiver laboratories offer a defined starting cohort; other certificate categories may also perform waived testing. For moderate- or high-complexity non-waived testing, Compliance and Accreditation are relevant starting categories, subject to the conditions in the CMS-116 instructions. A certificate category does not establish the laboratory’s actual testing menu or need for a particular product.

Decide what would justify prioritizing a state

Use one comparison brief: “Compare [facility setting] in Florida and California under [certificate categories], applying the same product requirements and source period.” Restrict both lists to territory your team can cover.

The observed population reversal explains why the eligibility definition matters. It does not predict which territory will generate more revenue.

Build a territory comparison in QOPE

Open QOPE Laboratories to investigate a defined cohort. For example, compare Physician Office records in Florida and California under the same certificate criteria.

QOPE’s dataset catalog documents state, facility-type, and certificate-type filters and lists Laboratories as a premium dataset on Pro and Teams. Its table guide and export guide describe this workflow:

1. Select one State, the relevant Facility type, and the chosen Certificate type values.
2. Record the filter selections, dataset freshness timestamp, and displayed row count.
3. Open Export, choose CSV, and inspect the offered sample. Select the available identifier, name, location, facility-type, and certificate-type fields needed for review.
4. Check the download count against the filtered total. The documented limit is 1,000 rows per file; a capped export may cover only part of the cohort.
5. Repeat for the other state using identical eligibility criteria. If narrower slices are needed, document them and check gaps and overlaps before combining files.

Review both files against the same brief. Mark records eligible only when the requirements are supported, ineligible when a disqualifier is established, and unknown when evidence is insufficient. Record evidence dates, resolve repeated identifiers and purchasing relationships, and report unreviewed records separately. A capped or selective review cannot establish a whole-state eligibility rate.

Verification limit: this workflow follows public documentation reviewed October 7, 2026; it has not been tested in a signed-in session. The CMS ranking is not a QOPE record-count ranking, and equivalence between the populations has not been established.

Reconciliation and interpretation limits

The listed 50-state non-exempt components sum to 283,072. Adding 15,247 exempt-program laboratories gives the 298,319 state-ranking denominator.

Separately, CMS publishes 285,470 non-exempt laboratories and 300,720 laboratories overall. Adding its exempt subtotal to the published non-exempt total yields 300,717, leaving an unexplained difference of three. We preserve the listed components and do not allocate that difference to states.

The checks performed were:

August 2026 is the report period, not an exact extraction day or annual average. Comparisons with the September rankings require a matching period before attributing differences to geography or certification. Counts do not establish volume, quality, demand, or current operations. CMS-116 permits qualifying multiple-location arrangements under one certificate, so registrations need not equal sites or accounts.

Comparing records or reporting periods

A distinct-identifier ranking needs a dated file, inclusion rules, and treatment of missing, repeated, and conflicting IDs. For month-to-month comparisons, retain both source reports and use identical geography and certificate definitions. Count changes alone do not establish openings, closures, or demand growth.

Sources

• CMS CLIA statistics, August 2026, pages 1 and 3–5: published components used in the calculations.
• CMS-116 application and instructions, March 2024 revision: certificate permissions and multiple-site provisions.
• QOPE dataset catalog, table guide, and export guide: documented access, filters, and export workflow.

CMS may replace the PDF at the same URL. Retain the August 2026 source when reproducing these calculations.