FAQ: CPT® PLA

PLA codes are alpha-numeric CPT® codes with a corresponding descriptor, for labs or manufacturers to more specifically identify their test. Tests with PLA codes must be performed on human specimens and must be requested by the clinical laboratory or manufacturer that offers the test.

PLA codes are contained in a non-Category I subsection of the Pathology/Laboratory CPT codes. When a specific PLA code is not listed, the test must be reported using either a CPT Category I laboratory code or an Administrative MAAA code, the later separately listed in Appendix O.

Proprietary Name and Clinical Laboratory or Manufacturer

ABC's Tumorous Analysis® ABC Lab Inc.

Alpha-Numeric Code: 81X01

Code Descriptor: Disease type, RNA, gene expression profiling by real-time RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin embedded tissue, algorithm reported as a recurrence score (example only)

PLA codes, which include many types of tests, have been assigned an alphanumeric structure to expand the code number capacity in the CPT code set and to distinguish these codes from other CPT codes.

Potential applicants for PLA codes should go to the PLA code application. You will be required to enter the names of any co-applicants, in addition to the requested pertinent test information.

Prior to submitting an application, applicants are encouraged to work with other industry representatives, relevant specialties whose members would logically order the test or AMA staff for any questions concerning the PLA code section or the CPT code set. Applicants who wish to contact the specialty societies prior to submitting an application should contact the departments of coding and reimbursement for the national specialty societies listed in the front matter of the CPT code book. Similarly, those who wish to contact the organizations representing qualified non-physician health care professionals that belong to the CPT Health Care Professionals Advisory Committee (HCPAC) should contact the departments of coding and reimbursement for these organizations that are listed in the front matter of the CPT code book.

After submitting the form, AMA/CPT staff will review the application to determine whether it addresses a new issue or presents significant new information about an item that the Panel reviewed previously. Staff will also look at responses to each question to verify that the information is complete. If this is not the case, the application will be returned to be completed within a defined timeframe (e.g., 5 business days). Applicants seeking multiple test codes will be required to submit a separate application for each test.

On receipt of the completed application, the application is published to the secure CPT website for review by the Proprietary Laboratory Analyses Technical Advisory Group (PLA-TAG). The PLA-TAG is composed of select representatives of the CPT Editorial Panel, the Pathology Coding Caucus, and the Molecular Pathology Advisory Group and payer organization(s). The remaining ad hoc members are composed of representatives from commercial labs, proprietary labs, academic labs, registries, payers and private practice. The PLA-TAG is an advisory body to the CPT Editorial Panel. Following their review of your application, the PLA-TAG will recommend action by the CPT Editorial Panel. You will receive notice of this recommendation.

You will receive an email notice from AMA shortly after the conclusion of the PLA-TAG meeting to notify you of any recommendations or alternate terminology for consideration by the panel. The Editorial Panel can:

• Accept your code request as written
• Accept your request with modification (e.g., altered descriptor terminology)
• Reject or postpone your request for a new or revised code

In addition, you will be notified if there are any further actions related to terminology or code status as a result of the panel's consideration of your request. If accepted, the wording of the code descriptor is included in the notice of acceptance. However, you may not release this information to any other parties until publication of the panel's decision to the CPT website. If your PLA code application is rejected or you believe incorrect terminology has been approved, you are offered the option to submit a request for reconsideration within 10 days of receipt of the notice. If the panel deems that additional information or evaluation is warranted, consideration of your application may be postponed until time certain (a specific future CPT meeting) or time uncertain. If your application is postponed, you will receive an email notice from AMA staff 2 weeks after the conclusion of the meeting, with specific instructions for the required information for resubmission of your application.

Possible actions that you can take are to:

• Agree with the panel recommendation
• Request panel consideration of your original option (in cases where the PLA-TAG has constructed an alternate nomenclature recommendation). The CPT Editorial Panel will make the final determination on your request.
• Withdraw your application

Yes, you may withdraw your application up to 3 days prior to consideration by the panel.

The codes in this new section will be issued on a quarterly basis (and effective the following quarter to allow payers time to load them into their systems). The date that you submit your application is included within a period for a particular agenda. All applications submitted prior to the deadline for application submission will be considered by the panel on the date defined in the calendar. The applicable posting and effective dates are applied to each submission period. Following the publication and effective date linked with the submission deadline and panel meeting date, you may begin using the new code to report your test.

No. When a PLA code is available to report a given proprietary laboratory service, that PLA code takes precedence. The service should not be reported with any other CPT code(s) and other CPT code(s) should not be used to report services that may be reported with that specific PLA code.