Revenue Cycle Insider

Also, gain valuable insights into CLFS payments.

In January, path/lab coders saw updates to both Category I CPT^® codes and Proprietary Laboratory Analyses (PLA) codes. Here’s what you need to know.

Check Out the New Category I Codes

The 2026 additions for Category I CPT^® codes range from testing for inherited chromosomal abnormalities to using a single specimen to check for COVID-19 and influenza. Here is a look at the codes:

• 81354 (Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities …) uses optical genome mapping (OGM), which produces high-resolution images of long strands of DNA, to evaluate the entire genome for constitutional chromosomal abnormalities, meaning those that are inherited or present from birth. On Medicare’s Clinical Laboratory Fee Schedule (CLFS), the national payment amount is $1,263.53.
• 81524 (Oncology (central nervous system tumor), DNA methylation analysis …) involves methylation analysis of a central nervous system tumor to detect chemical markers called methyl groups. Methylation refers to a chemical change to DNA that can affect gene activity and is often altered in cancer. The test also applies one or more algorithms to compare the methylation profile of the patient’s tumor to a large reference database of tumor families and classes. This code is locally priced for Medicare, so you won’t find a national payment amount for it on the CLFS.
• 87182 and 87183 (Susceptibility studies, antimicrobial agent …) are antimicrobial susceptibility studies that specifically evaluate carbapenem resistance. Carbapenems are a class of powerful antibiotics often used when other antibiotics are ineffective. Code 87182 describes testing using a multiplex immunoassay, which can identify several enzymes at once and reports results qualitatively (positive or negative). Code 87183 describes testing using an amplified probe technique, which detects the presence of specific genetic markers associated with resistance. Code 87182 is locally priced, but 87183 has a national payment amount of $35.09 on the CLFS.
• 87494 (Infectious agent detection by nucleic acid (DNA or RNA) …) involves a combined test for Chlamydia trachomatis and Neisseria gonorrhoeae. This code applies when a single multiplex test detects both organisms. The CLFS national payment amount for 87494 is $70.18.
• 87627 (Infectious agent detection by nucleic acid (DNA or RNA) …) is a multiplex nucleic acid test that detects joint space pathogens (such as those in a knee or hip) and drug resistance genes in a single assay. The test simultaneously screens for at least 26 different organisms and resistance markers. The CLFS national payment rate is $679.77.
• 87812 (Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation …) detects both SARS-CoV-2, which causes coronavirus disease (COVID-19), and influenza virus types A and B from a single specimen. This code allows reporting of a combined rapid test. The CLFS national payment rate is $74.48.

Revised codes: The January 2026 update also revised 83015 and 83018 by adding gadolinium to the list of examples and moving antimony to make the list alphabetical: (Heavy metal (eg, antimony, arsenic, barium, beryllium, bismuth, gadolinium, mercury) …). Code 83015 has a national payment rate of $20.94, while 83018 pays $21.96.

Prepare for These PLA Additions and Subtractions

The AMA updates the PLA codes every quarter, so you need to watch for updates in January, April, July, and October. In January, the code set added 14 PLA codes, deleted 10, and made a few other updates, including one test name change. New PLA codes are contractor-priced (where applicable) until they are nationally priced and undergo the CLFS annual payment determination process.

Here’s a look at the new PLA codes:

• 0600U (Infectious disease (wound infection), identification of 65 organisms and 30 antibiotic resistance genes …) identifies microorganisms that cause wound infections and detects antibiotic resistance genes. Each organism is reported as positive or negative, helping guide appropriate antimicrobial therapy (Test Name: FidaLab Molecular Wound Infection Test; Lab/Manufacturer: FidaLab LLC).
• 0601U (Infectious disease (periprosthetic joint infection), analysis of 11 biomarkers …) evaluates synovial fluid (joint fluid) for infection around joint implants. A diagnostic algorithm combines the results to produce a probability score indicating the likelihood of periprosthetic joint infection (PJI) (Test Name: Synovasure^® Comprehensive PJI Test Panel with SynTuition™; Lab/Manufacturer: CD Laboratories Inc., a division of Zimmer Biomet).
• 0602U (Endocrinology (diabetes), insulin (INS) gene methylation …) evaluates a patient’s risk of developing diabetes by analyzing both genetic and biochemical markers. These combined results are processed through an algorithm that produces a diabetes-risk score (Test Name: Kihealth Inc^® Diabetes Risk Test; Lab/Manufacturer: Kihealth Inc^® Laboratory).
• 0603U (Drug assay, presumptive, 77 drugs or metabolites …) provides a presumptive drug screen that detects the possible presence of 77 drugs and metabolites. A presumptive test identifies possible use or nonuse of a drug or drug class but does not provide definitive identification or quantification (Test Name: SLL Comprehensive Drug Analysis; Lab/Manufacturer: Soft Landing Labs).
• 0604U (Allergy and immunology (chronic recurrent angioedema), 4 bradykinin peptides …) measures levels of four forms of bradykinin peptides, which are small proteins that expand blood vessels and increase vascular permeability. The test reports quantitative values for each peptide form to assist in evaluating chronic recurrent angioedema (Test Name: Bradykinin, Quantitative, by LC-MS/MS; Lab/Manufacturer: Virant Diagnostics Inc).
• 0605U (Allergy and immunology (hereditary alpha tryptasemia), DNA, analysis …) analyzes DNA from whole blood to determine the number of copies of the TPSAB1 gene, which encodes alpha tryptase, a protein involved in allergic and inflammatory responses. The test classifies results as normal or abnormal based on an algorithm and genotype-specific interpretation (Test Name: Tryptase Gene Copy Number Analysis by dPCR; Lab/Manufacturer: Virant Diagnostics Inc).
• 0606U (Hematology (red cell membrane disorders), RBCs …) evaluates the mechanical properties and deformability of red blood cells (RBCs) to help diagnose inherited or acquired red cell membrane disorders (Test Name: Osmotic Gradient Ektacytometry; Lab/Manufacturer: Cincinnati Children’s Clinical Laboratories, RR Mechatronics).
• 0607U (Reproductive medicine (endometrial microbiome assessment) …) evaluates the balance of bacteria in the endometrium (the uterine lining). Results include quantified bacterial levels and treatment recommendations aimed at optimizing uterine microbiome health for reproductive success (Test Name: EMMA [Endometrial Microbiome Metagenomic Analysis]; Lab/Manufacturer: Igenomix^®).
• 0608U (Reproductive medicine (endometrial microbiome assessment) …) detects and measures bacterial DNA targets from an endometrial biopsy. The test identifies microorganisms linked to chronic endometritis (long-term inflammation of the endometrium, the inner lining of the uterus). The test reports quantified bacterial levels and provides treatment recommendations to help restore a healthy uterine environment (Test Name: ALICE [Analysis of Infectious Chronic Endometritis]; Lab/Manufacturer: Igenomix^®).
• 0609U (Oncology (prostate), immunoassay …) measures total and free prostate-specific antigen (PSA) levels and combines the results with clinical data to calculate a probability score for clinically significant prostate cancer (Test Name: ClarityDX Prostate; Lab/Manufacturer: Protean BioDiagnostics, Nanostics Inc.).
• 0610U (Infectious disease (antimicrobial susceptibility) …) evaluates how bacteria from a positive blood culture respond to multiple antibiotics (Test Name: LifeScale Gram Negative Kit [LSGN] with the LifeScale AST system; Lab/Manufacturer: Affinity Biosensors LLC).
• 0611U and 0612U have identical descriptors: (Oncology (liver), analysis of over 1,000 methylated regions, cell-free DNA from plasma, algorithm reported as a quantitative result.) The tests analyze cell-free DNA (small fragments of DNA released into the bloodstream from cells) to detect methylation patterns in over 1,000 regions of the genome. The results are processed through an algorithm that provides a quantitative result to assess liver cancer risk (0611U Test Name: HelioHCC™ Strat; 0612U Test Name: HelioHCC™ Trace; Lab/Manufacturer: Helio Genomics^®).
• 0613U (Oncology (urothelial carcinoma) …) detects DNA changes related to bladder and upper urinary tract cancers. An algorithm combines the data to produce a probability index for bladder cancer and urothelial carcinoma (Test Name: AssureMDx™; Lab/Manufacturer: Vesica Health^® Inc.).

Name change: In addition to fixing a typo and adding or deleting commas in various descriptors, the January update also changed the test name associated with 0524U (Obstetrics (preeclampsia), sFlt-1/PlGF ratio, immunoassay …). The addition of “PreClara™ Ratio” resulted in the current name: PreClara™ Ratio (sFlt-1/PlGF).

Drop These PLA Deletions

For 2026 services, make sure you aren’t using these deleted codes:

• 0033U (Htr2a (5-hydroxytryptamine receptor 2a), htr2c (5-hydroxytryptamine receptor 2c) (eg, citalopram metabolism) gene analysis …) guided choices of antidepressants and antipsychotic medications (Test Name: Serotonin Receptor Genotype [HTR2A and HTR2C]; Lab/Manufacturer: Mayo Clinic).
• +0131U (Hereditary breast cancer-related disorders …), +0132U (Hereditary ovarian cancer-related disorders …), and +0135U (Hereditary gynecological cancer …) helped with classification of genes implicated in various hereditary cancer-related disorders (+0131U Test Name: +RNAinsight™ for BreastNext^®; +0132U Test Name: +RNAinsight™ for OvaNext^®; +0135U Test Name: +RNAinsight™ for GYNPlus^®; Lab/Manufacturer: Ambry Genetics).
• 0361U (Neurofilament light chain, digital immunoassay …) aided in evaluating patients for neurodegenerative diseases (Test Name: Neurofilament Light Chain [NfL]; Lab/Manufacturer: Mayo Clinic).
• 0508U (Transplantation medicine …), 0509U (Transplantation medicine …), and 0544U (Nephrology (transplant monitoring) …) helped providers assess risk of rejection for transplanted kidneys (0508U Test Name: VitaGraft™ Kidney Baseline + 1st Plasma Test; 0509U Test Name: VitaGraft™ Kidney Subsequent; 0544U Test Name: VitaGraft™ Kidney 2.0; Lab/Manufacturer: Oncocyte Corporation).
• 0550U (Oncology (prostate) …) combined test results and patient data to provide a risk score for high-grade prostate cancer (Test Name: ClarityDx Prostate; Lab/Manufacturer: Protean BioDiagnostics).
• 0551U (Tau, phosphorylated, ptau217 …) measured the levels of phosphorylated tau protein (pTau217). The test provides information for assessing the presence of Alzheimer’s disease (Test Name: LucentAD p-Tau 217; Lab/Manufacturer: Quanterix Corporation).

And Get a Jump on Q2

The AMA has already released the code changes for April 1, including the addition of 17 codes, from 0614U (Inborn error of metabolism (primary mitochondrial disease) …) to 0630U (Oncology (breast), mRNA, gene expression profiling …).

The April update also revises two codes. The first revision adds the term “liquid chromatography” to 0256U (Trimethylamine/trimethylamine N-oxide (TMA/TMAO) profile, liquid chromatography tandem mass spectrometry …). The second revision adds the term Lyme disease and increases the number of recombinant protein groups from 24 to 31 in 0580U (Borrelia burgdorferi (Lyme disease), antibody detection of 31 recombinant protein groups, by immunoassay, IgG).

The proprietary name associated with 0319U (Nephrology (renal transplant), RNA expression by select transcriptome sequencing, using pretransplant peripheral blood, algorithm reported as a risk score for early acute rejection) will change from Clarava™ to PreTransplant Risk Assessment (PTRA).

Go here for the full list of recent PLA updates.

Deborah Marsh, JD, MA, CPC, CHONC, Managing Editor, AAPC