AMA’s New PLA Code Updates for Q3: What You Need to Know

PLA codes are alphanumeric CPT codes designed to identify unique, proprietary clinical laboratory tests performed on human specimens. It is managed by the AMA’s CPT Editorial Panel, these codes support precise billing for tests like Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs) under the Protecting Access to Medicare Act of 2014 (PAMA).

PLA codes are 4 digits and end with a “U” (e.g., 0285U, 0552U) to distinguish them from numeric CPT codes. Each code is tied to a specific test, laboratory, or manufacturer listed in the AMA’s CPT code book under the “Proprietary Laboratory Analyses” section and detailed in Appendix O. PLA codes are recognized by the Centers for Medicare & Medicaid Services (CMS) for Medicare reimbursement under PAMA. They cover tests for various specialties, including oncology, infectious diseases, genetic disorders, and drug metabolism. All tests must be performed on human specimens and meet criteria for ADLTs or Clinical Diagnostic Laboratory Tests (CDLTs) under PAMA.

PLA codes are managed by the AMA’s CPT Editorial Panel, which reviews applications for new codes quarterly. Laboratories or manufacturers submit applications to the AMA for a PLA code, detailing the test’s methodology, proprietary name, and clinical utility. The CPT Editorial Panel reviews applications during quarterly meetings. Approved codes are released on a quarterly basis (January, April, July, October) and published in the next CPT code book edition. We at Shoreline Medical Billing Company closely monitor AMA’s quarterly PLA code updates and CMS’s announcements for changes to reimbursement rates or coding guidelines.

Based on the AMA’s announcements, the Q3 2025 PLA code updates include:

New Codes (0552U–0574U)

Revised Code Descriptors

Deleted Codes

23 new PLA codes were introduced, spanning several medical specialties such as

✔ Reproductive/Genetic Testing (0552U–0555U): Preimplantation embryo screening

✔ Oncology (0558U–0574U): Tumor gene panels, liquid biopsies, cancer risk assays

✔ Infectious Disease (0556U–0557U, 0563U–0564U): DNA panels for respiratory pathogens and vaginitis, including multiplex RT‑PCR tests for viruses and bacteria

✔ Neurology/Trauma (0568U, 0570U): Biomarker panels for Alzheimer’s and traumatic brain injury

✔ Rare Diseases (0567U): Whole-genome sequencing for constitutional disorders

These codes are listed in Appendix O with specific proprietary names and manufacturers.

✔ Code 0285U: Updated to clarify its use for oncology monitoring, including response to radiation or chemotherapy via cell-free DNA and branched chain DNA amplification in plasma.

✔ Codes 0089U, 0220U, 0393U, 0420U, 0522U: The proprietary names and/or manufacturers associated with these codes were updated to reflect current branding, ownership, or test specifications.

Six PLA codes (0240U, 0241U, 0369U, 0370U, 0373U, 0374U) are removed, effective July 1, 2025. Providers must stop using these codes and check for replacements or alternative CPT codes.

✔ Understand and Review the New PLA Codes (0552U–0574U)

✔ Update the EHR (Electronic Health Record) & PMS (Practice Management System)

✔ Train the coding and Billing Staffs

✔ Discontinue Deleted PLA Codes

✔ Integrate with Charge Capture Processes

✔ Verify Payer Policies and Coverage

✔ Monitor Claim Submission and Denials using new PLA Codes

✔ Perform periodic internal Audit

We Shoreline Medical Billing company stands out as a premier partner for implementing the new PLA codes in your RCM process due to its comprehensive services and expertise:

✔ Certified Coding Experts: Shoreline’s team of AAPC- and AHIMA-certified coders ensures accurate PLA code selection and compliance with AMA and CMS guidelines.

✔ Advanced Technology: Our proprietary billing platform integrates seamlessly with major EHR systems, automating PLA code updates and charge capture.

✔ Proactive Denial Management: Shoreline’s dedicated team reduces denials by verifying payer policies and appealing rejections with robust documentation.

✔ Customized Training: Tailored training programs and resources empower our staffs to handle PLA codes confidently.

✔ Data-Driven Insights: Shoreline’s analytics tools optimize reimbursement and identify RCM inefficiencies, ensuring maximum revenue.

✔ Compliance Focus: Regular audits and real-time updates keep our practice aligned with AMA and CMS regulations, minimizing audit risks.

Review your billing processes now to incorporate the new PLA codes and avoid claim denials.

Sharanya brings clarity to the complexities of medical billing and healthcare regulations. With a knack for turning industry shifts into straightforward, actionable insights, her blogs help readers stay informed without the jargon.

Contact Shoreline Medical Billing company specialist in coding, billing and revenue cycle management.

Shoreline Medical Billing provides specialized revenue cycle management, certified coding audits, and proactive denial prevention to help medical practices thrive. Contact our advisory team to schedule a complimentary practice assessment.