Thursday, April 2, 2020

AMA Releases Newest PLA Codes (Submitted Jan 1, Released Apr 1) - Next Comment Period April 8

AMA produces PLA codes at lightning speed - applications are due quarterly (circa Jan 1, April 1, July 1, October 1).    There is a very brief public comment period thereafter.   The PLA subcommittee revised and votes on the codes soon (this month, April 22) and the codes will be voted on (somewhat pro-forma) by CPT editorial committee a few weeks after that.

  • Heads up: The second quarter PLA applicants (submitted in the last couple days) will be posted for public comment on April 8, and this is a very brief window (after that, the cohort of codes submitted April 1 will be taken down and hidden until posted as final around July 1).

Read the New PLA Codes Online

The big news is that on April 1, AMA posted the PLA codes voted on and completed during the first quarter.   You can read the codes now; they will be "active" for example for Medicare claims, on July 1, 2020.    This cohort of codes will also be on the agenda of the summer CMS lab test pricing meetings ("crosswalk-gapfill meetings.") 

The home page for PLA codes is here.
The PDF of brand new April 1 codes is >>>  here.
   (Link for PDF at bottom of the PLA home page.

AMA has deleted 5 codes but added 30, and revised one (0068U).  Note that AMA has been touchy about when a PLA code can be "revised" and when a revision represents "a new test therefore a new code."  For 0068U, it looks like the brand name (not the code text itself) changed.

The deleted codes were mostly represented by deleted prenatal biochemistry screening tests held by Eurofins.

In reading the PDF, which is 12 pages, note that it lists (old) new codes for October 1 and January 1 prior to new-new codes for April 1.   This is because this PDF is a listing of all PLA codes that have not been otherwise previously published in the yearly AMA CPT manual.  Thus, the new-new April 1 codes are on page 9-12 of this PDF.

What Hath PLA Wrought?

Grifols has codes 0180U-0201U for RBC typing singly or in panels.

Other new codes run from 0172U to 0179U and include a number of oncology gene panels and also psychiatry panels.

Myriad MyChoice is here 0172U, which is also an ADLT (see CMS ADLT webpage.)  CMS has priced it at $4040 here.