Don't miss the January 1, 2026 update on newly awarded PLA codes, because AMA seems to use this channel to convey new (or newly emphasized) rules for the PLA code system.
I wrote a blog on November 19 that AMA had put some new PLA text in the 2026 edition of the CPT handbook. I was concerned the updates were vague. E.g. a list of changes that MAY trigger the need for a new PLA code. "MAY???" How about, do or do not require a new code??
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Find the January 1 update here:
https://www.ama-assn.org/system/files/cpt-pla-codes-long.pdf
There are 17 new codes, 2 revised codes, and some revised text. Some of the 2026 manualized revised text appears now in the PLA code list PDF, but I think there are some items only in one place (manual) or the other (code list PDF).
- Tests may be provided by a sole source lab, at the most, there could be multiple locations owned by the same entity. (If you want sequencing at Lab A and bioinformatics at Lab B, you're out.)
- PLA codes must not have a physician work component. (E.g. they must all be eliglbe for the Clin Lab fee schedule at CMS - no physician work, which would trigger professional components paid for inpatients and trigger RVU valuation).
- An algorithm-only analysis is not eligible for a PLA code.
- (I believe this is defined to include digital pathology eg DICOM reads of prior slides).
- If a PLA coded tests is elevated to Category I it gets a new code (e.g. 8nnnn). They will time deletion of the PLA code to the first day of the new code.
Like the 2026 6CPT book, that say that certain changes "MAY" require a new code (not that the changes "do" or "do not") which seems like exceptionally cryptic wording to me.
Similarly, an addition or modification of therapeutic applications requires a code change submission, BUT IT MAY OR MAYNOT require a changed code number. "Thanks for clarifying that."
