Wednesday, January 31, 2024

Medicare Nerd Tip: A Back Door to Putting Together Labs and their PLA Codes

Header: Michigan Blue Cross publishes a PDF which lists every PLA code, name of test, and name of lab owner.  You can't easily get this from AMA or CMS.


One of the pitfalls of PLA codes is that there are some 500 of them, and they are in random order (from date of approval).   Another problem is that it's very painful to search the AMA CPT manual page by page looking for all the PLA codes a lab (say, Biodesix) might have.  The CMS CLFS fee schedule and even the subscription AMA RVU database, list PLA codes but not owners.

Aha.  Michigan Blue Cross publishes a PDF of all active PLA codes, with the code number, the code name (or brand name like "Cxbladder-TM", and then the owner.  Since this is a PDF file, you can search it for keywords (say, Biodesix).  This shows in a second that Biodesix has 2 PLA codes,  PLA 0080U for BDX-XL2 test, and 0360U for Nodify CDT test.

Find the table here:

AI Corner

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