April update to the OPPS includes new CPT codes for Proprietary Laboratory Analyses
The April 2018 OPPS update adds new CPT codes for proprietary laboratory analyses (PLA) to the Integrated Outpatient Code Editor (I/OCE), effective on claims for advanced diagnostic laboratory tests and clinical diagnostic laboratory tests.
The AMA CPT Editorial Panel introduced 11 new PLA CPT codes, 0024U-0034U, for a range of medical laboratory tests including, but not limited to, multianalyte assays with algorithmic analyses and genomic sequencing procedures. New codes include:
- 0024U, glycosylated acute phase proteins (GlcA), nuclear resonance spectroscopy, quantitative
- 0026U, oncology (thyroid), DNA and mRNA of 112 genes, next-generation sequencing, fine needle aspirate of thyroid nodule, algorithmic analysis reported as a categorical result (“Positive, high probability of malignancy” or “Negative, low probability of malignancy”)
- 0030U, drug metabolism (warfarin drug response), targeted sequence analysis (i.e., CYP2C9, CYP4F2, VKORC1, rs12777823)
The update also removed two PLA codes from the I/OCE:
- 0004U, infectious disease (bacterial), DNA, 27 resistance genes, PCR amplification and probe hybridization in microarray format (molecular detection and identification of AmpC, carbapenemase and ESBL coding genes), bacterial culture colonies, report of genes detected or not detected, per isolate
- 0015U, drug metabolism (adverse drug reactions), DNA, 22 drug metabolism and transporter genes, real time PCR, blood or buccal swab, genotype and metabolizer status for therapeutic decision support
All code changes have an effective date of January 1. The AMA released the codes in December, but they were published too late to be included in the January 2018 OPPS update.
CPT PLA code updates, along with their descriptions and status indicators, are listed in the April 2018 OPPS Addendum B. More detailed information on the April 2018 OPPS update can be found in MLN Matters. To learn more about PLA codes, see the AMA’s website.