Healthcare Fraud Shield’s Latest Article: Understanding COVID-19 PLA Codes

31 Aug

If you have billed, paid or audited laboratory services there is a good chance you have encountered PLA codes, those alpha-numeric procedure codes ending in “U”. According to the American Medical Association (AMA), “Proprietary Laboratory Analyses (PLA) Codes are an addition to the Current Procedural Terminology (CPT) code set approved by the AMA CPT Editorial Panel. They are alpha-numeric CPT codes with a corresponding descriptor for labs or manufacturers that want to more specifically identify their test.”[1]

Each quarter AMA CPT accepts applications for new PLA codes. Those applications are processed, and the PLA number is assigned. The code numbers and descriptors are released quarterly. For example, on July 1, 2021 AMA CPT released seven new PLA codes 0248U to 0254U. These codes will be included in the CPT® 2022 publication.[2] In addition, PLA code revisions and deletions are detailed in the quarterly report.

PLA for COVID-19

During the COVID-19 period, new PLA code descriptions related to COVID-19 testing are being reviewed and processed in an expedited manner. The codes are published within a few weeks of application, rather than waiting for the quarterly AMA CPT PLA report.

COVID-19 related PLA codes recently published or revised include:

  • 0202U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected
  • 0223U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected
  • 0224U Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed
  • 0225U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific DNA and RNA, 21 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RJNA targets, each analyte reported as detected or not detected
  • 0226U Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(Coronavirus disease [COVID-19]), ELISA, plasma, serum
  • 0240U Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected.
  • 0241U Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected.

COVID-19 PLA concerns to look for:

Beware of duplicate PLA codes, where more than one manufacturer has proprietary tests for the same targets. For example, PLA code 0202U (BioFire® Respiratory Panel 2.1) and PLA code 0223U (QIAstat-Dx Respiratory SARS-CoV-2 Panel) are identified by CPT as having identical clinical descriptors (duplicates).[3]

Watch for PLA codes that are a duplication of CPT Category I codes. For example, PLA CPT code 0240U and CPT code 87636 both describe testing for the same three targets.

  • 0240U Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected.
  • 87636 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

Similarly, PLA CPT code 0241U and CPT code 87637 both describe testing for the same four targets.

  • 0241U Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected.
  • 87637 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

Pay close attention to PLA panel codes billed with single lab test(s) billed for the same day that may duplicate one or more of the panel target(s). Note the PLA descriptions that indicate “each pathogen reported as detected or not detected” and verify the billed codes and pathogens are supported by corresponding lab reports.

REFERENCES

[1] www.ama-assn.org/practice-management/cpt/cpt-pla-codes

[2] www.ama-assn.org/system/files/cpt-pla-codes-short.pdf

[3] www.aapc.com/codes/cpt-codes/0202U If you have any questions or comments, please reach out to SIU@hcfraudshield.com.

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