Monday, August 3, 2026

CMS Denial Rates for PLA Codes

 CMS has a terrific database where you can see all codes (services) paid for any US laboratory.  Find it here.

CMS also has a database for all CPT codes paid to Part B providers and labs, along with denial rates.  These tables are national, and are not provider specific.  But, if the code is a sole-lab PLA code, it's almost the same as provider specific.  Database here.

I ran a search for PLA codes 037U (FMI CGP Paraffin) and 0239U (FMI CGP LBx).

The table breaks the codes up into multiple lines for obscure reasons (e.g. some will go through the "Palmetto Railroad Retiree Contractor.")   See below for the fragmented lines.

But the data count in the main rows here (with around 13000 cases for 0037U and around 7000 cases for 0239U0) match up with other sourcecs for 2024.

The FMI PLA code denial rate appears to be... about 4% in those main rows.  QED.

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A person could search the data for all codes ending in "U" and get several hundrred rows in Excel.  You could then sort for most popular PLA codes, most denied PLA code, most denied dollars per PLA code, etc.