Revenue Cycle Insider

One specialty makes up almost half of the October codes.

The October update to Proprietary Laboratory Analyses (PLA) CPT^® codes is now in play. Take a little time to see what’s new for labs and which of the 45 additions might affect you.

Tip: If you use coding books, these PLA updates will be published in CPT^® 2025, but they were effective Oct. 1, 2024. Each PLA code describes a unique lab test made by a specific manufacturer or performed by a specific lab. When a PLA code is available to report a service, you must use that PLA code rather than another code from the CPT^® Pathology and Laboratory code range.

Check Out New Codes Category by Category

The 45 new codes for October range from 0476U-0520U. Here’s an overview of the tests:

Oncology/tumor: There are 19 new codes that fall under the category of oncology and tumors, making it the largest group of additions. To offer some examples, 0478U represents gene analysis related to non-small cell lung cancer, 0485U represents next-generation sequencing (NGS) for a solid tumor, 0495U represents circulating plasma protein analysis for prostate cancer, 0499U represents NGS for colorectal and lung cancer, and 0507U represents whole-genome sequencing for ovarian cancer.

HPV: New code 0502U is for a new test for human papillomavirus (HPV). This mRNA test relates to oncology as well, because it analyzes the sample for high-risk types of HPV, meaning those most likely to cause cervical cancer.

Drug metabolism: The update includes three codes related to drug metabolism. The tests analyze an individual’s genetic makeup to understand how they metabolize specific medications. This testing helps predict a person’s response to drugs. Two of the new codes, 0476U and 0477U, are specific to psychiatry — the third code is 0516U (Drug metabolism, whole blood, pharmacogenomic genotyping of 40 genes and CYP2D6 copy number variant analysis ...). All three include analysis of CYP2D6, which is a gene that encodes an enzyme responsible for metabolism of many commonly prescribed drugs.

Drug monitoring: There are four new codes for therapeutic drug monitoring, all of which use liquid chromatography-tandem mass spectrometry (LC-MS/MS) to separate, identify, and quantify compounds in mixtures. Code 0517U involves 80 or more psychoactive drugs or substances; 0518U involves 90 or more pain and mental health drugs or substances; 0519U applies to 110 or more pain, depression, and anxiety drugs or substances; and 0520U applies to 200 or more prescribed and nonprescribed drugs or substances.

Autoinflammatory disease: Code 0500U represents testing for VEXAS syndrome, a rare inflammatory disorder characterized by various systemic symptoms, including fever, skin rashes, and bone marrow abnormalities. It is caused by mutations in the UBA1 gene and primarily affects men.

Alzheimer’s disease: Two new codes represent tests looking at biomarkers of Alzheimer’s. Code 0479U focuses on phosphorylated tau protein, while 0503U tests a wider range, including tau and beta amyloid proteins.

Gastroenterology: Code 0506U represents an NGS test reported as likelihood for Barrett’s esophagus. Two other new gastroenterology codes are immunoassays for patients with irritable bowel disease to determine their levels of the medication adalimumab (0514U) or infliximab (0515U).

Infectious disease: The new infectious disease codes cover a variety of areas:

• 0480U (Infectious disease (bacteria, viruses, fungi, and parasites), cerebrospinal fluid (CSF), metagenomic next-generation sequencing (DNA and RNA), bioinformatic analysis, with positive pathogen identification)
• 0483U (Infectious disease (Neisseria gonorrhoeae), sensitivity, ciprofloxacin resistance (gyrA S91F point mutation), oral, rectal, or vaginal swab, algorithm reported as probability of fluoroquinolone resistance)
• 0484U (Infectious disease (Mycoplasma genitalium), macrolide sensitivity (23S rRNA point mutation), oral, rectal, or vaginal swab, algorithm reported as probability of macrolide resistance)
• 0504U (Infectious disease (urinary tract infection), identification of 17 pathologic organisms, urine, real-time PCR, reported as positive or negative for each organism)
• 0505U (Infectious disease (vaginal infection), identification of 32 pathogenic organisms, swab, real-time PCR, reported as positive or negative for each organism)

Obstetrics: The obstetrics codes include tests for both the mother and the fetus. First, 0482U is a biochemical assay to assess risk of preeclampsia with severe features. Code 0488U uses cell-free DNA sequence analysis to help with identification and management of patients at risk of severe hemolytic disease of the fetus and newborn (HDFN). HDFN is caused by a blood-type incompatibility between the mother and fetus, typically because the mother is Rh-negative and her immune system produces antibodies that attack the red blood cells of an Rh-positive fetus. Similarly, the test represented by 0494U analyzes the fetal DNA in the mother’s blood to check for the RhD gene, which helps determine if the fetus is Rh-positive or Rh-negative. Finally, 0489U involves cell-free DNA sequence analysis and focuses on fetal risk score for inherited conditions, like cystic fibrosis.

Transplantation medicine: Three codes represent testing for how much cell-free DNA a donor organ has released into the patient’s bloodstream. The information helps with predicting organ rejection. Code 0493U uses NGS, 0508U uses 40 single-nucleotide polymorphisms (genetic variations, also called SNPs), and 0509U uses 12 SNPs.

Be Sure to Catch Revisions and Deletions, too

There are also two code revisions. First, 0248U (Oncology, spheroid cell culture in 3D microenvironment, 12-drug panel, brain- or brain metastasis-response prediction for each drug) had some minor editing changes. More importantly, the revised descriptor refers to “brain- or brain metastasis-response prediction.” The prior descriptor, (Oncology (brain), spheroid cell culture in a 3D microenvironment, 12 drug panel, tumor-response prediction for each drug), did not reference brain metastasis.

The second revision is to 0403U (Oncology (prostate), mRNA, gene expression profiling of 18 genes, first-catch urine, algorithm reported as percentage of likelihood of detecting clinically significant prostate cancer). The updated code descriptor downsizes the previous wording of “first-catch post-digital rectal examination urine (or processed first-catch urine)” to “first-catch urine.”

The three deleted codes are 0078U (Pain management (opioid-use disorder) genotyping panel …), 0167U (Gonadotropin, chorionic (hCG), immunoassay with direct optical observation, blood), and 0396U (Obstetrics (pre-implantation genetic testing), evaluation of 300000 DNA single-nucleotide polymorphisms …).

Deborah Marsh, JD, MA, CPC, CHONC, Sr. Development Editor, AAPC