Wiki Proprietary Laboratory Analysis (PLA) Codes

[Loan K Vo]

Hello,

Is there an expert to advise how PLA codes being applied? According to AMA, PLA codes take precedence CPT Category I codes and CPT Category I code(s) should not be used to report services that may be reported with that specific PLA code.
https://www.ama-assn.org/practice-management/cpt/faq-cpt-pla

Does anyone have any experiences or a crosswalk on when to use PLA vs CPT Category I?

Much Appreciated.

 

[karamac]

Per Diane Vorhees Proprietary laboratory analyses (PLA) codes describe proprietary clinical laboratory analyses and can be either provided by a single (“sole-source”) laboratory or licensed or marketed to multiple providing laboratories (eg, cleared or approved by the Food and Drug Administration [FDA]). When a PLA code is available to report a given proprietary laboratory service, that PLA code takes precedence.- Guidance from Diane Vorhees, M.A. CLS, MT, SH, CPCO

https://www.labinstitute.com/wp-con...ng-Billing-Compliance-2020-Diana-Voorhees.pdf

PLA codes are proprietary and/or specific to the Laboratory, method, assay, equipment etc. that is being used. It would be helpful to understand what PLA code you are trying to bill? Crosswalking in laboratory refers more to how a code is priced. I may be misunderstanding your question?

 

[hqureshi]

I am still confused can an emergency department bill PLA codes for the test performed. E.g we have two codes for Xpert® Xpress SARS CoV-2/Flu/RSV (SARS[1]CoV-2 & Flu targets only), Cepheid..One is from 8000 series as 87637 while the other is 0241U (PLA code) and the test is performed in Emergency department,

 

[otdoc321]

I am still confused can an emergency department bill PLA codes for the test performed. E.g we have two codes for Xpert® Xpress SARS CoV-2/Flu/RSV (SARS[1]CoV-2 & Flu targets only), Cepheid..One is from 8000 series as 87637 while the other is 0241U (PLA code) and the test is performed in Emergency department,

We also use the Xpert Xpress from Cepheid. You would only use the 0241U if you are reporting all four targets (SARS CoV-2, Flu A, Flu B, and RSV). If you are only reporting the CoV-2 and Flu targets, use the CPT code. We have the same issue, and that was the consensus of our coding experts.