Effective July 1, 2025, the AMA released new Proprietary Laboratory Analysis (PLA) codes and made some revisions. There are 23 new PLA code updates (0552U–0574U) approved by the CPT Editorial Panel, one code revised, and six others removed.
These changes will be found in CPT 2026 released in October 2025 and go into effect this quarter. Keeping current with these changes is extremely important for proper coding, compliance, and revenue integrity.
If your billing system continues to use an outdated PLA code or omits a new one, claims may be denied or paid at lower levels. This guide details the most significant changes and how they will impact your billing operations.
New PLA Codes Take Effect July 1, 2025
This quarter’s news includes 23 new PLA codes for various advanced tests. New codes span a variety of medical specialties: reproductive genetics (preimplantation embryo screening), oncology (tumor genomic testing and cancer markers), infectious disease (pathogen panels), neurology (brain injury and dementia markers), and rare genetic disorders.
In short, if the lab test wasn’t already listed in the CPT 80000-series, it is likely that it now does have a new PLA code. For example, four new codes (0552U–0555U) are for preimplantation genetic testing for embryo.
Dozens of new codes related to oncology (0558U–0574U) are for tumor DNA testing and cancer risk assessment. As one large insurance company explains, many new PLA codes will be accepted for precertification beginning July 2025.
• Added codes. AMA added a total of 23 special test codes (0552U to 0574U). They must be added to your billing software by July 1, 2025 (CMS reports they will be added to the HCPCS file and priced by MACs for their areas).
• Included areas. The new codes contain approximately four for reproductive and genetic testing, eleven for cancer testing, five for infectious diseases testing, two for brain testing, and one for testing for rare diseases (whole-genome analysis).
• Reproductive/Genetic: 0552U–0555U (genetic assessment of IVF embryos).
• Oncology: 0558U–0559U (markers for breast and colorectal cancer); 0560U–0562U (minimal residual disease and 33-gene tumor panels); 0565U–0567U (advanced sequencing tests for liver, lung, and rare diseases); 0571U–0573U (liquid biopsy, telomere length measurement, pancreatic cyst evaluation).
• Infectious Disease: 0556U–0557U (DNA panels for respiratory conditions and vaginitis); 0563U–0564U (panels for 11 viruses/4 bacteria and 10 viruses/4 bacteria related to respiratory issues); 0574U (TB CFP-10 antigen detection via mass spectrometry).
• Neurology/Trauma: 0568U (biomarkers for Alzheimer’s: Aβ, pTau, NfL, GFAP); 0570U (assay for traumatic brain injury: GFAP and UCH-L1).
• Rare Genetic: 0567U (whole-genome sequencing for constitutional disorders).
| Code | Test Category | Description (example) |
|---|---|---|
| 0552U | Embryo Genetics | Preimplantation genetic diagnosis (trophectoderm biopsy) for inherited mutation. |
| 0562U | Oncology/Genomics | 33-gene panel focused NGS of tumor cell-free DNA (solid tumor) is used to detect important SNVs and indels. |
| 0563U | Infectious Disease | Respiratory pathogen panel (11 viruses + 4 bacteria) by multiplex RT-PCR, from upper airway sample. |
| 0568U | Neurology (Dementia) | Plasma ultrasensitive assay of Aβ peptides, pTau217, NfL, GFAP in Alzheimer pathology. |
| 0573U | Oncology (Pancreas) | Pancreatic cyst fluid analysis (glucose, CEA, gastricsin); algorithm differentiates mucinous vs non-mucinous. |
Table: Sample new PLA code updates effective July 1, 2025, with test descriptions (according to AMA guidelines)
These examples show that PLA codes now contain many “laboratory-developed tests” (LDTs) with specific algorithms. In CPT policy, if there is a PLA code for a service, you must use it in lieu of any general Category I CPT® code.
That is, you can’t add a test with a PLA code to another lab code – the PLA code encompasses all steps of testing. For coders and billers, this means your staff should always look in the Proprietary Laboratory Analyses section for these services.
In the event your lab partners inform you of a new test with a PLA code, ensure your billing software can utilize the new code (such as 0552U, etc.) beginning July 1. Many payers – including Medicare MACs – are adopting these codes into their systems and will post them in the Clinical Laboratory Fee Schedule.
PLA Code Changes and Deletes
The Q3 update includes some new codes and some modifications to existing PLA codes: one modification and some codes have been deleted.
AMA reports that 0285U (Oncotype risk score) has a new description that takes effect April 1, 2025.
The new description indicates results are reported “as ng/mL of a radiation toxicity score,” which is a new test process. (Be sure to update any codebooks or EHR text for 0285U accordingly.)
Six PLA codes are being removed starting July 1, 2025. They include 0240U and 0241U (which were used on some tests for a respiratory virus) and 0369U, 0370U, 0373U, and 0374U.
For example, PLA 0240U/0241U were originally used for COVID-19 and flu tests; they have been retired and replaced by the usual CPT codes 87636 and 87637 (for COVID, flu, and RSV tests).
CMS clearly states that these six PLA codes are being deleted July 1, 2025. After that date, claims with a deleted PLA code will be denied – the service should be billed using the correct CPT code(s) instead.
(Remember: AMA policy says that a PLA code is only used if still active; if it’s been deleted, use the regular codes.)
Removed PLA Codes (effective 7/1/25): 0240U, 0241U, 0369U, 0370U, 0373U, 0374U. Your billing rules need to eliminate these codes effective June 30, 2025.For reference, AMA has stated these are “6 codes deleted with an effective date of July 1, 2025”.
Impact on Coding and Billing Operations
These PLA updates do have an impact on coding personnel and billing practices. That is, this is:
• Update your code tables. Ensure that your practice management and EHR systems include all 23 new PLA codes (0552U–0574U) and remove the six deleted codes.
CMS assures the new PLA codes will be added to the national HCPCS file on July 1, so most billing systems will get them automatically. Ensure code 0240U, 0241U, and 0369U–0374U are removed or marked as inactive by mid-2025.
• Verify billing rules. Older PLA codes can still be subject to older rules for some insurance companies. BlueCross BlueShield, for example, has updated its genetic testing policy to cover the new codes of 7/1/25. Look on large insurance websites or MLN for announcements (e.g. Medicare’s MLN MM14055, revised April 2025, details PLA code updates for CLFS).
If your lab personnel haven’t indicated a new code, take the initiative: ask them for CPT numbers for the special tests they are performing.
• Train your staff. Don’t miss it: AMA instructions state that if a PLA code is available, use it and it must be used for all analytic work. Train coders to look in the “PLA” section of CPT first before assigning any other code to a specialty lab test.
Also remind them that these PLA updates are quarterly, not annually. AMA states that “PLA code updates will be published electronically, distributed via CPT data files on a quarterly basis.” Encourage staff to check Billing Xpert Blog webpage or subscribe to coding newsletters so they won’t miss an update next quarter.
• Update the form templates. If your organization is printing order forms or templates containing PLA codes, be sure to update them.
For instance, any reference to “0240U” on an outdated form should be replaced with 87636 (COVID/flu/RSV panel) in the future. New form fields may also be required for the alphanumeric PLA codes (which do not print as well in fields containing only numbers).
• Reimbursements. Check payment notices in July 2025 when the new codes are used. If a claim is denied at $0 or denied for an unrecognized code error, check that you used the proper new PLA code and whether it was active.
CMS states that for Q3 new PLA codes, MACs will only price them for labs in their area, so reimbursement could be different if multiple MACs serve your area. For the codes that were removed, check that 87636/87637 (or other category I codes) are submitted on claims instead of 0240U/0241U starting July 1.
Don’t miss this quarterly update. Using these new PLA codes correctly ensures you report the tests actually performed (and payers will reimburse for).
In compliance and coding, remember this: each new PLA code is a new “charge item” your practice can bill, and each deleted code is something you should discontinue using. Timely change is necessary to prevent money or compliance loss.
With Human Medical Billing, we handle tricky coding updates such as recent PLA code updates so that your practice is compliant and paid faster. We stay on the lookout for AMA, CMS, and payer updates so your systems, fee schedules, and forms are current on the most recent coding standards.
If you have a small clinic or large practice with several specialties, we assist you to automate updates, reduce denials, and increase revenue accuracy via active coding verification and matching payor policies. Don’t let coding delays hurt your cash flow. Join forces with Human Medical Billing to keep your practice moving forward.
Staying Current with AMA News
The AMA has also kept the PLA code process up to date and transparent. New codes and updates are published every three months (typically Jan 1, April 1, July 1, Oct 1) and are available online.
As an example, the Spring 2025 meeting agenda posted April 15, and final code updates were published July 1.
AMA states clearly: “the CPT PLA code will be published electronically on a quarterly basis” and to look on their website for the most current PLA list. That is, coding managers can bookmark the AMA CPT-PLA page or create alerts (many coding news websites also send notifications).
Staying current is not a nice added bonus – it keeps revenue secure. Every PLA code corresponds to a particular lab test with a Medicare fee and payment rule all its own. If you use an outdated or deleted code, your claim can’t be paid properly.
Conversely, if you fail to use a new PLA code, you could report fewer services and charge less for work that can be reimbursed.
In reality, coding instructors emphasize that the correct use of PLA codes is extremely crucial in maintaining revenue robust: whenever a new test emerges (and receives a PLA code), clinics should ensure they capture that revenue.
While AMA and CMS control the code definitions, AMA recommends practices remain vigilant: “check the AMA website for updates” every three months, and update your chargemaster immediately.
Key Updates for Coders and Billers
•23 new PLA codes (0552U–0574U) become effective on July 1, 2025. The broad areas are genetics (e.g., preimplantation testing), oncology (tumor gene tests, biomarkers), infections (respiratory tests), neurology (brain injury markers), and rare disease testing.
• Effective July 1, 6 PLA codes were removed (0240U, 0241U, 0369U, 0370U, 0373U, 0374U). The tests need to be reported using regular CPT codes (e.g., 87636/87637 for COVID/flu panels).
•1 updated PLA code (0285U) with a new description. Update any internal documentation to reflect the new long descriptor.
• Report the PLA code if it is present. AMA policy is that PLA codes take precedence over Category I codes for the same test. Report only the PLA code (not a category code) if a provider orders an unusual test.
• Update rapidly. Update your EMR and billing systems with the new codes, remove the deleted codes, and update your fee schedules/chargemasters. Educate staff and providers on the new codes and how to use them.
• Check payer directives. Search for payer bulletins (CMS MLN, Medicaid/Medicare MAC, large payers) for PLA code charges. For Medicare, the new PLA codes will be contractor-priced under CLFS until a yearly rate is established. Check that billing staff are aware that as of July 1, PLA codes 0552U–0574U are accepted by Medicare and private payers.
• Read AMA’s quarterly reports. Mark reminder: future PLA panel votes are in July, new codes effective Oct 1, 2025. Bookmark AMA’s CPT-PLA web page in the interim or sign up for coding newsletters to be reminded.
Keeping abreast of these CPT updates isn’t merely a paper exercise – it directly influences the level of compliant your practice is and its bottom line. Properly coded PLA tests guarantee payments are made correctly and your clinic gets the full value of its specialty laboratory work. On the other hand, a missed update can lead to rejections or reduced payment. In the rapidly evolving lab testing landscape, the AMA’s quarterly releases of codes are your key to correct billing. Ensure that your staff reports these updates with increased scrutiny every quarter.
