Navigating PLA Coding: Our Starter Toolkit
The Proprietary Laboratory Analysis (PLA) Coding Toolkit
This PLA Coding Toolkit Includes:
- What PLA Codes Are
- The Approval Process
- Our Process
- PLA Codes FAQs
- Why Gettysburg Healthcare Consulting
- Your Next Step
PLA Codes Defined
A Proprietary Laboratory Analysis (PLA) Codes is an alpha-numeric CPT code and a corresponding descriptor used by clinical laboratories or diagnostic test manufacturers that want a code to uniquely identify their test.
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Requirements for Obtaining a PLA Code
Tests that are assigned a PLA code must be performed on human specimens. The PLA code must be requested by the manufacturer of the test or by the clinical laboratory that offers the test.
The PLA Code Approval Process
From start to finish, the process can take 6 to 9 months.
We start with a review of your test so that we can develop the application. The AMA's Proprietary Laboratory Analysis Technical Advisory Group meets quarterly to review new PLA applications.
We will submit your PLA application about a month prior to the meeting. Codes are released about 3 months after the meeting and they become effective 6 months after the meeting.
We leave no stone unturned in developing and clearly communicating our pricing decision to CMS, and we follow up diligently to ensure your test receives the favorable payment it deserves.
At Gettysburg Healthcare Consulting, we are dedicated to being your trusted Medicare and Medicaid policy professionals, guiding you through every step of this intricate journey.
Our Payment Policy Experience
At Gettysburg Healthcare Consulting, we have assembled a team of Medicare and Medicaid policy pros who are dedicated to delivering top-notch consulting services.
With years of experience and in-depth knowledge, our team is committed to helping you navigate the complex world of healthcare policy. Whether you need assistance with compliance, reimbursement, or strategic planning, our experts are here to guide you every step of the way. Trust Gettysburg Healthcare Consulting for all your healthcare consulting needs.
Our Expertise Shines
- Working with an experienced healthcare consultant with over 30 years of Medicare program experience gives you a level of knowledge and skill unmatched in the industry.
- Our comprehensive understanding of AMA coding rules and requirements helps avoid pitfalls and mistakes.
- Clients trust us to review their novel diagnostics and determine the best coding approach for their unique needs.
Get the Codes to Maximize Your Revenue!
Our experts know the ins and outs of obtaining the right billing codes, so your product can start generating income as soon as possible.
PLA Code FAQs
When should I start thinking about a PLA code?
We recommend starting this process as soon as possible. A good benchmark is to start developing the PLA application at least 6 months before you launch your test.
What kinds of information do I need to support a PLA code?
We can complete the application for you if you have the information that explains:
- How your test works
- Where it's performed
- What it measures
How is a PLA code different than a CPT code?
PLA codes ARE CPT codes.
They are NOT Category I CPT codes, which means that you don’t have to demonstrate the same level of clinical usage.
This is ideal for your new diagnostic.
Are there any risks to obtaining a PLA code?
The biggest challenge labs face with PLA codes is ensuring all payers, including Medicaid, recognize and accept the code.
Our team has helped other clients do just that.
What is the benefit of obtaining a PLA code?
The biggest benefit is having your own unique code that describes only your test. It cannot be used to report a claim for any other test. This gives you more control than a typical Category I CPT code that can describe several tests.
Does Medicare pay differently for PLA codes?
No. PLA codes are processed through the Medicare annual Clinical Laboratory Fee Schedule pricing meeting just like any other laboratory test code.
What do I do next?
Book a free 30-minute consultation, and we can discuss your options.
Why Choose Gettysburg Healthcare Consulting
At Gettysburg Healthcare Consulting, we are experts in Medicare and Medicaid policy. With years of industry experience, our team of professionals is dedicated to helping healthcare providers navigate the complex world of healthcare regulations. We understand the challenges you face and are committed to providing you with the knowledge and guidance you need to succeed. Trust the policy pros at Gettysburg Healthcare Consulting to help you achieve your goals.