AMA PLA Code Set Policy (Captured August 3, 2016)

http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/announcements-reports/shaping-the-cpt-lab-code-set.page?

August 3, 2016
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Shape the CPT® Proprietary Lab Analyses Code Set

On June 17, 2016, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule. This Final Rule implements the Protecting Access to Medicare Act (PAMA) provisions pertaining to pricing and coding for clinical laboratory tests covered on the Medicare Clinical Lab Fee Schedule (CLFS), as well as reporting requirements for clinical laboratories performing these tests.

The Final Rule requires that CMS:

• Issue Healthcare Common Procedure Coding System (HCPCS) codes to identify new advanced diagnostic laboratory tests (ADLTs), and clinical tests that are cleared or approved by the Food and Drug Administration (FDA) (referred to as Clinical Diagnostic Laboratory Tests, or CDLTs) if an applicable CPT code (HCPCS level I) does not exist; and
• Provide upon request either a HCPCS code or unique identifier for test tracking and monitoring.

In order to address these coding provisions, the CPT Editorial Panel approved in November 2015, and finalized at the February 2016 Panel meeting, the new Proprietary Lab Analyses (PLA) section of the CPT code set.  In addition, the Panel approved the creation of the Proprietary Laboratory Analyses Advisory Group.

Announcing the AMA CPT Proprietary Laboratory Analyses Technical Advisory Group (PLA-TAG)

An important part of the development of this new set of codes is that industry and other stakeholders, including subject matter experts, actively participate in the PLA process. To that end, the Panel will be creating the PLA-TAG which will advise the Panel on applications received for codes to be added to the new PLA section of CPT.  Along with representation by the Panel and certain Panel workgroups, the PLA-TAG will be composed of individuals with expertise relating to the services covered under the new CPT PLA section. These may include, but are not limited to, members from various industry segments such as independent labs performing molecular diagnostic services, private payers, professional/industry organizations, commercial labs, academia and private practitioners.

Members of PLA-TAG will play a crucial role in the PLA code creation process by reviewing PLA CPT code change applications and making recommendations regarding these requests for CPT codes that describe ADLTs or CDLTs.  

Become a Member of the Proprietary Lab Analyses Advisory Group

We are currently seeking nominations for individuals to serve on the PLA-TAG. The PLA-TAG will be most effective with comprehensive representation from a broad range of health care segments. PLA-TAG membership will require significant commitment to review code change applications and will require participation in meetings (predominantly telemeetings) a minimum of 4 times per year.  PLA-TAG members will need to strictly follow CPT rules and policies, including conflict of interest disclosure requirements and obligations to maintain confidentiality.  Those interested in applying for a PLA-TAG position should review these policies prior to submitting an application. To be considered for the PLA-TAG, please submit an application for consideration no later than Friday, Aug. 12, 2016.

The Panel appreciates your interest in this initiative, and looks forward to convening the PLA-TAG over the next several months to prepare for the launch of the new CPT PLA code section in 2017. If you have questions, please contact Marie Mindeman marie.mindeman@ama-assn.org or Jay Ahlman at jay.ahlman@ama-assn.org.