The American Medical Association (AMA) released its quarterly update to the CPT Proprietary Laboratory Analyses (PLA) codes within the Pathology and Laboratory section on October 1st. These crucial modifications, though effective January 1, 2026, will be formally published in the CPT 2027 codebook due to the timing of the release cycle.
Summary of Revisions
The latest tranche of updates necessitates careful review by all coding professionals involved in laboratory billing. The changes are as follows:
- Deletions: 10 PLA codes have been retired.
- Additions: 14 new PLA codes have been introduced (a range, e.g., 0600U-0613U).
- Revisions: 14 existing codes have been technically revised.
- Proprietary Name Changes: 1 code has an updated proprietary name.
- Descriptor Revisions: 5 codes have modifications to their long descriptors.
Understanding Proprietary Laboratory Analyses (PLA) Codes
PLA codes are a distinct category, generally positioned at the conclusion of the CPT Pathology and Laboratory section. They encompass a broad spectrum of advanced services, including:
- Advanced Diagnostic Laboratory Tests (ADLTs)
- Clinical Diagnostic Laboratory Tests (CDLTs)
- Multianalyte Assays with Algorithmic Analyses (MAAAs)
- Genomic Sequencing Procedures (GSPs)
Critical Coding Note: For accurate code assignment, coders must consult the full descriptors and cross-reference them with the proprietary names listed in Appendix O of the CPT codebook. This is essential because some PLA codes may have similar or near-identical descriptions, making the proprietary name the definitive identifier for correct service capture.
Detailed Breakdown of Code Changes
The CPT Editorial Panel’s approved changes, effective 01/01/2026, mandate a thorough audit of current laboratory charge masters and billing systems.
Deletions and New Additions
The 10 deleted codes include procedures that measured various analytes, such as:
- 0033U (Serotonin receptor genotype)
- 0509U (RNAinsight™ for BreastNext)
- 0551U (VitaGraft™ Kidney Baseline + 1st Plasma Test)
The 14 new PLA codes (0600U-0613U) are introduced to report recently developed and approved tests. Examples of these new services include:
- 0600U: A comprehensive test for identifying 65 organisms and 30 antibiotic resistance genes in an infected wound, crucial for guiding infectious disease treatment.
- 0602U: A procedure specifically designed for assessing diabetes risk.
- 0603U: A new code for a presumptive drug assay.
Descriptor and Proprietary Name Changes
Code descriptor revisions occur when the scope of a test changes, such as the addition or modification of therapeutic applications.
Example of Descriptor Revision (Change in Scope):
The descriptor for 0365U has been substantially updated to reflect a more comprehensive methodology:
- Revised 0365U: Oncology (bladder), 10 protein biomarkers (A1AT, ANG, APOE, CA9, IL8, MMP9, MMP10, PAI1, SDC1, and VEGFA) by immunoassays, urine, diagnostic algorithm, including patient’s age, race, and gender, reported as a probability of harboring urothelial cancer. (The inclusion of specific biomarkers and demographic factors highlights the algorithmic change in the test.)
Example of Proprietary Name Revision:
The revision for 0524U is purely an update to the manufacturer’s trade name:
- Revised 0524U Proprietary Name: Changed to PreClara™ Ratio (sFIt-1/PIGF), Thermo Fisher Scientific.
Example of Technical Corrections:
Some updates are essential administrative or technical edits to ensure accuracy:
- 0596U: Corrected the spelling from “prototype” to “proteotype” within the descriptor.
- 0537U: The numerical value was corrected from ‘2500’ to ‘2,500‘ for proper formatting.
These updates underscore the necessity for coders to remain current with all AMA CPT literature to maintain optimal coding compliance and reduce claim denials for these specialized laboratory procedures.
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