Explore our free mid-revenue cycle articles and webinars here.

Ask a Rev Cycle Expert: Are PLA codes mostly for physician billing?

Question:

Are PLA codes considered to be mostly for physician billing? For 0241U, the manufacture stated the PLA code was to be used to report for their test. Is it appropriate for hospital billing to report 0241U, or should we use 87637?

Answer:

If the laboratory test has a Proprietary Laboratory Analysis (PLA) code available, then the PLA code should be assigned, regardless of whether this is for facility or professional billing. For example, Current Procedural Terminology (CPT®) code 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 should be used to report Cepheid laboratory’s Xpert® Xpress SARS-CoV-2/Flu/RSV test when all of the targets are tested. If the test you are performing is not by Cepheid laboratory, then CPT® code 87637 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique would be used.


CPT® Assistant, 2020 Special Edition, October Update: COVID-19 Coding Update

“…To report a PLA code, the analysis performed must fulfill the code descriptor and must be the test represented by the proprietary name….”

Disclaimer: This information was current at the time of its publishing and is designed to provide accurate information in regard to the subject matter covered. Vitalware does not accept any responsibility or liability with regard to any errors, omissions, misuses, or misinterpretation by the reader. It is not intended to take the place of either the written policies or regulations. We encourage you to review the specific regulations and other interpretive materials as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).