Monday, October 3, 2022

AMA Releases Nine New Final PLA Codes (Effective Jan. 1, 2023)

Each quarter, AMA releases a new batch of PLA codes.   These were submitted about 90 days before the release date, and, will be "effective" 90 days later.   

Heads up, applications for new PLA codes are due October 4, and new regular CPT codes due November 2.  The former will be posted for comments in about a week, the latter will be posted for comments around November 14.  

Find the just-released October 1 PLA codes here:

Note that AMA issues a running tally of all PLA codes too recent to be in the current year's book.   The 2022 book went up to 0284U, and this code list funs from 0285U down to 0363U.   It also includes numerous codes with smaller or larger editorial changes in the past year.  

Quest AD Detect, 0346U, is now effective (October 1) and is being priced by CMS (at a very low price).  Myriad Genesight 0345U is also now effective October 1, and is being priced by CMS (currently at a crosswalk of $1336).   Read about the current CMS pricing on these effective-October-1 codes here.

Newly released codes for use January 1, 2023, begin at 0355U (QUEST ApoL1 risk variants.)  See full code names at the AMA PDF link above, but I'll give very short informal summaries to help orient you to the new codes.

  • 0355U, Quest APO-L
  • 0356U, Naveris, oral cancer, 17 risk score markers
  • 0357U, InterVenn, DAWN AI & Mass Spec test of 142 analytes for melanoma immuno oncology benefit
    • (See Genomeweb this week for an RNA SEQ test that may outperform PDL1 here.)
  • 0358U, FujiReBio, FDA cleared 2-biomarker CSF test for Alzheimer's
    • Note that Quest LDT plasma Alzheimer amyloid test 0346U made this summer's pricing cycle, while 0358U FujiReBio FDA CSF Alzheimer test will be in next summer's pricing cycle.
  • 0359U, Cleveland Dx, IsoPSA, PSA isoforms
  • 0360U, Biodesix Nodify CDT, 7 autoantibodies for lung cancer diagnosis
    • Biodesix frequently applies for ADLT status, so we'll watch for that on this code.
  • 0361U, Mayo NFL (neurofilament light) for neurology, digital immunoassay, quantitative
    • Next summer, we'll watch how pricing compares to Quest's 0355U.  
    • Digital assays for proteomics are a rising platform.
  • 0362U, Protean, Thyroid GuidePX, 82 genes for thyroid cancer subtypes
  • 0363U, Pacific Edge, CXBLADDER Triage, 0363U, 5 gene bladder cancer risk
    • This test was in the news over the summer.  June here.  July here.
    • Note that Pacific Edge also has codes 0012M, 0013M, the first for risk of urothelial carcinoma, the second for risk of recurrence, both are 5 gene MAAAs.  CMS Pt B use CY2020 was 1,353 for the '12M and 640 for '13M ($760).  


As I noted in a recent blog, there are some weird things in how CMS assigns hospital outpatient status indicators.  For example, 0342U (Immunovia IMMRAY Pancreatic cancer diagnostic, "E1" not payable by statute) and 0343U (MIR Scientific MIR Sentinel, prostate sncRNA test, "E1" not payable by statute).  Here.  Almost no lab codes get OPPS APC status of E1 = banned by law.   Odd.