FAQs: CPT® PLA

For an overview PLA codes, including eligibility requirements, how to apply, and a calendar of key dates, please visit our CPT® PLA codes main page.

The FAQs on this page address procedural and situational questions.

What does a PLA code and descriptor look like?

Download the PDF for PLA descriptor guidelines and examples.

How do I know if my application is complete?

After submitting the code change application, AMA CPT staff will review each response to ensure the application is complete. If any response or required documentation is missing, your application will be returned to you to be completed within two business days. Please note, incomplete code change applications may be postponed to another cycle or subject to termination.

Who will review my code change application?

Once your completed code change application is received, it is posted for review by the Proprietary Laboratory Analyses Technical Advisory Group (PLA-TAG). This advisory group includes representatives from the CPT Editorial Panel, Pathology Coding Caucus, Molecular Pathology Advisory Group, payer organizations, commercial and proprietary labs, academic labs, registries, and private practice. After their review, the PLA-TAG will recommend an action to the CPT Editorial Panel for adopting the test in the code set. If necessary, applicants may be contacted during the PLA-TAG meeting to discuss their code change application. Applicants will be contacted during the meeting if their attendance is required.

After the PLA-TAG meeting you will receive an email from the AMA notifying you of any recommendations or alternate terminology for the Panel’s consideration. Upon review, the CPT Editorial Panel may:

• Accept your code request as written
• Accept your request with modifications (such as changes to descriptor terminology)
• Reject your request
• Postpone consideration for a future meeting if additional information or evaluation is needed

If accepted, the wording of the code descriptor is included in the notice of acceptance. However, you may not release this information to any other parties until publication of the CPT codes to the CPT website.

The AMA facilitates code creation and Centers for Medicare & Medicaid Services (CMS) and other payors make coverage determinations. The AMA shares newly accepted codes with CMS as part of its quarterly code release process. CMS uses this information to include new codes in the Clinical Laboratory Fee Schedule (CLFS) for pricing and payment. Please contact Centers for Medicare & Medicaid Services (CMS) and other payors to present your rationale for pricing.

If your PLA code application is rejected or you believe incorrect terminology has been approved, you are offered the option to submit a request for reconsideration within 10 days of receipt of the notice.

If the panel deems that additional information or evaluation is warranted, consideration of your application may be postponed until time certain (a specific future CPT meeting) or time uncertain.

If your application is postponed, you will receive an email notice from AMA staff two weeks after the conclusion of the meeting, with specific instructions for the required information for resubmission of your application.

May I withdraw my code change application? If so, when?

Yes, you may withdraw your code change application at any time before the agenda item is called at the Panel meeting. Once discussion of your code change application has begun at the Panel meeting, withdrawal is no longer permitted.

If my application is not accepted or I disagree with the Panel’s decision, what are my options?

If your application is rejected, or if you believe the terminology is incorrect, you may request reconsideration within 10 days of receiving the notice. If additional information is required, you will be notified within two weeks after the meeting with instructions for resubmission.

When can I start reporting a new PLA code after approval?

New PLA codes are released quarterly and become effective in the following quarter. Once your code is approved and the publication and effective date has been reached (as specified on the PLA Editorial Panel meetings and calendar) you may begin using the new code to report your test.

If I get a PLA code for my test, can I also report it with a Category I CPT code?

No. When a PLA code is available for a proprietary laboratory service, it must be used exclusively for reporting that service. Other CPT codes should not be used to report the same test.

Contact us

For technical assistance or questions about the code change application process, contact [email protected].

CPT® is a registered trademark of the American Medical Association.