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PLA Codes

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2018
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IMPORTANT NOTICE: Updated W-9 for new address 3/1/18 available here.

CPT® Proprietary Laboratory Analyses (PLA) Codes


PLA Code
Description
Test Name
Lab Name
Manufacturer
Effective Date
0001U
Red blood cell antigen typing, DNA, human erythrocyte antigen gene analysis of 35 antigens from 11 blood groups, utilizing whole blood, common RBC alleles reported PreciseTypeÆ HEA Test Immucor, Inc. Immucor, Inc.
02/01/2017
0002U
Oncology (colorectal), quantitative assessment of three urine metabolites (ascorbic acid, succinic acid and carnitine) by liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring acquisition, algorithm reported as likelihood of adenomatous polyps PolypDXô Atlantic Diagnostic Laboratories, LLC Metabolomic Technologies Inc.
02/01/2017
0003U
Oncology (ovarian) biochemical assays of five proteins (apolipoprotein A-1, CA 125 II, follicle stimulating hormone, human epididymis protein 4, transferrin), utilizing serum, algorithm reported as a likelihood score Overa (OVA1 Next Generation) Aspira Labs, Inc. Vermillion, Inc.
02/01/2017
0005U
Oncology (prostate) gene expression profile by real-time RT-PCR of 3 genes (ERG, PCA3, and SPDEF), urine, algorithm reported as risk score ExosomeDxÆProstate (IntelliScore) Exosome Diagnostics, Inc. Exosome Diagnostics, Inc.
05/01/2017
0006U
Prescription drug monitoring, 120 or more drugs and substances, definitive tandem mass spectrometry with chromatography, urine, qualitative report of presence (including quantitative levels, when detected) or absence of each drug or substance with description and severity of potential interactions, with identified substances, per date of service Aegis Drug-Drug Interaction Test Aegis Sciences Corporation Aegis Sciences Corporation
08/01/2017
0007U
Drug test(s), presumptive, with definitive confirmation of positive results, any number of drug classes, urine, includes specimen verification including DNA authentication in comparison to buccal DNA, per date of service ToxProtect Genotox Laboratories LTD Genotox Laboratories LTD
08/01/2017
0008U
Helicobacter pylori detection and antibiotic resistance, DNA, 16S and 23S rRNA, gyrA, pbp1, rdxA and rpoB, next generation sequencing, formalin-fixed paraffin-embedded or fresh tissue, predictive, reported as positive or negative for resistance to clarithromycin, fluoroquinolones, metronidazole, amoxicillin, tetracycline and rifabutin AmHPR Helicobacter pylori Antibiotic Resistance Next Generation Sequencing Panel American Molecular Laboratories, Inc. American Molecular Laboratories, Inc.
08/01/2017
0009U
Oncology (breast cancer), ERBB2 (HER2) copy number by FISH, tumor cells from formalin-fixed paraffin-embedded tissue isolated using image-based dielectrophoresis (DEP) sorting, reported as ERBB2 gene amplified or non-amplified DEPArrayTM HER2 PacificDx PacificDx
08/01/2017
0010U
Infectious disease (bacterial), strain typing by whole genome sequencing, phylogenetic-based report of strain relatedness, per submitted isolate Bacterial StrainTyping by Whole Genome Sequencing (WGS) Mayo Clinic Mayo Clinic
08/01/2017
0011U
Prescription drug monitoring, evaluation of drugs present by LC-MS/MS, using oral fluid, reported as a comparison to an estimated steady-state range, per date of service including all drug compounds and metabolites Cordant CORE® Cordant Health Solutions Cordant Health Solutions
08/01/2017
0012U
Germline disorders, gene rearrangement detection by whole genome next-generation sequencing, DNA, whole blood, report of specific gene rearrangement(s) MatePair Targeted Rearrangements, Congenital Mayo Clinic Mayo Clinic
08/01/2017
0013U
Oncology (solid organ neoplasia), gene rearrangement detection by whole genome next-generation sequencing, DNA, fresh or frozen tissue or cells, report of specific gene rearrangement(s) MatePair Targeted Rearrangements, Oncology, Mayo Clinic Mayo Clinic
08/01/2017
0014U
Hematology (hematolymphoid neoplasia), gene rearrangement detection by whole genome next-generation sequencing, DNA, whole blood or bone marrow, report of specific gene rearrangement(s) MatePair Targeted Rearrangements, Hematologic Mayo Clinic Mayo Clinic
08/01/2017
0016U
Oncology (hematolymphoid neoplasia), RNA, BCR/ABL1 major and minor breakpoint fusion transcripts, quantitative PCR amplification, blood or bone marrow, report of fusion not detected or detected with quantitation BCR-ABL1 major and minor breakpoint fusion transcripts University of Iowa, Department of Pathology Asuragen
08/01/2017
0017U
Oncology (hematolymphoid neoplasia), JAK2 mutation, DNA, PCR amplification of exons 12-14 and sequence analysis, blood or bone marrow, report of JAK2 mutation not detected or detected JAK2 Mutation University of Iowa, Department of Pathology University of Iowa, Department of Pathology
08/01/2017
0018U
Oncology (thyroid), microRNA profiling by RT-PCR of 10 microRNA sequences, utilizing fine needle aspirate, algorithm reported as a positive or negative result for moderate to high risk of malignancy ThyraMIR Interpace Diagnostics Interpace Diagnostics
10/01/2017
0019U
Oncology, RNA, gene expression by whole transcriptome sequencing, formalin-fixed paraffin embedded tissue or fresh frozen tissue, predictive algorithm reported as potential targets for therapeutic agents OncoTarget/OncoTreat Columbia University Department of Pathology and Cell Biology Darwin Health
10/01/2017
0020U
Drug test(s), presumptive, with definitive confirmation of positive results, any number of drug classes, urine, with specimen verification including DNA authentication in comparison to buccal DNA, per date of service ToxLok InSource Diagnostics InSource Diagnostics
10/01/2017
0021U
Oncology (prostate), detection of 8 autoantibodies (ARF 6, NKX3-1, 5í-UTR-BMI1, CEP 164, 3í-UTR-Ropporin, Desmocollin, AURKAIP-1, CSNK2A2), multiplexed immunoassay and flow cytometry serum, algorithm reported as risk score ApifinyÆ Armune BioScience Inc. Armune BioScience Inc.
10/01/2017
0022U
Targeted genomic sequence analysis panel, non-small cell lung neoplasia, DNA and RNA analysis, 23 genes, interrogation for sequence variants and rearrangements, reported as presence/absence of variants and associated therapy(ies) to consider Oncomineô Dx Target Test Thermo Fisher Scientific Thermo Fisher Scientific
10/01/2017
0023U
Oncology (acute myelogenous leukemia), DNA, genotyping of internal tandem duplication, p.D835, p.I836, using mononuclear cells, reported as detection or non-detection of FLT3 mutation and indication for or against the use of midostaurin LeukoStratÆ CDx FLT3 Mutation Assay LabPMM LLC, an Invivoscribe Technologies, Inc. company Invivoscribe Technologies, Inc.
10/01/2017
0024U
Glycosylated acute phase proteins (GlycA), nuclear magnetic resonance spectroscopy, quantitative GlycA Laboratory Corporation of America Laboratory Corporation of America
01/01/2018
0025U
Tenofovir, by liquid chromatography with tandem mass spectrometry (LC-MS/MS), urine, quantitative UrSure Tenofovir Quantification Test Synergy Medical Laboratories UrSure Inc.
01/01/2018
0026U
Oncology (thyroid), DNA and mRNA of 112 genes, next-generation sequencing, fine needle aspirate of thyroid nodule, algorithmic analysis reported as a categorical result ("Positive, high probability of malignancy" or "Negative, low probability of malignancy") Thyroseq Genomic Classifier CBLPath, Inc. University of Pittsburgh Medical Center
01/01/2018
0027U
JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, targeted sequence analysis exons 12-15 JAK2 Exons 12 to 15 Sequencing Mayo Clinic Mayo Clinic
01/01/2018
0028U
CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, copy number variants, common variants with reflex to targeted sequence analysis CYP2D6 Genotype Cascade Mayo Clinic Mayo Clinic
01/01/2018
0029U
Drug metabolism (adverse drug reactions and drug response), targeted sequence analysis (ie, CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP4F2, SLCO1B1, VKORC1 and rs12777823) Focused Pharmacogenomics Panel Mayo Clinic Mayo Clinic
01/01/2018
0030U
Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs12777823) Warfarin Response Genotype Mayo Clinic Mayo Clinic
01/01/2018
0031U
CYP1A2 (cytochrome P450 family 1, subfamily A, member 2)(eg, drug metabolism) gene analysis, common variants (ie, *1F, *1K, *6, *7) Cytochrome P450 1A2 Genotype Mayo Clinic Mayo Clinic
01/01/2018
0032U
COMT (catechol-O-methyltransferase)(drug metabolism) gene analysis, c.472G>A (rs4680) variant Catechol-O-Methyltransferase (COMT) Genotype Mayo Clinic Mayo Clinic
01/01/2018
0033U
HTR2A (5-hydroxytryptamine receptor 2A), HTR2C (5-hydroxytryptamine receptor 2C) (eg, citalopram metabolism) gene analysis, common variants (ie, HTR2A rs7997012 [c.614-2211T>C], HTR2C rs3813929 [c.-759C>T] and rs1414334 [c.551-3008C>G]) Serotonin Receptor Genotype (HTR2A and HTR2C) Mayo Clinic Mayo Clinic
01/01/2018
0034U
TPMT (thiopurine S-methyltransferase), NUDT15 (nudix hydroxylase 15)(eg, thiopurine metabolism) gene analysis, common variants (ie, TPMT *2, *3A, *3B, *3C, *4, *5, *6, *8, *12; NUDT15 *3, *4, *5) Thiopurine Methyltransferase (TPMT) and Nudix Hydrolase (NUDT15) Genotyping Mayo Clinic Mayo Clinic
01/01/2018
0035U
Neurology (prion disease), cerebrospinal fluid, detection of prion protein by quaking-induced conformational conversion, qualitative Real-time quaking-induced conversion for prion detection (RT-QuIC) National Prion Disease Pathology Surveillance Center National Prion Disease Pathology Surveillance Center
04/01/2018
0036U
Exome (ie, somatic mutations); paired formalin fixed paraffin embedded tumor tissue and normal specimen, sequence analyses EXaCT-1 Whole Exome Testing Lab of Oncology-Molecular Detection Weill Cornell Medicine - Clinical Genomics Laboratory
04/01/2018
0037U
Targeted genomic sequence analysis, solid organ neoplasm, DNA analysis of 324 genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability and tumor mutational burden FoundationOne CDxô (F1CDx) Foundation Medicine, Inc. Foundation Medicine, Inc.
04/01/2018
0038U
Vitamin D, 25 hydroxy D2 and D3, by LC-MS/MS, serum microsample, quantitative SensievaTM Droplet 25OH Vitamin D2/D3 Microvolume LC/MS Assay InSource Diagnostics InSource Diagnostics
04/01/2018
0039U
Deoxyribonucleic acid (DNA) antibody; double stranded, high avidity Anti-dsDNA, High Salt/Avidity University of Washington, Department of Laboratory Medicine Bio-Rad
04/01/2018
0040U
BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis, major breakpoint, quantitative MRDx BCR-ABL Test MolecularMD MolecularMD
04/01/2018
0041U
Borrelia burgdorferi, antibody detection of 5 recombinant protein groups, by immunoblot, IgM Lyme ImmunoBlot IgM IGeneX Inc ID-FISH Technology Inc. (ASR) (Lyme ImmunoBlot IgM Strips Only)
04/01/2018
0042U
Borrelia burgdorferi, antibody detection of 12 recombinant protein groups, by immunoblot, IgG Lyme ImmunoBlots IgG IGeneX Inc ID-FISH Technology Inc. (ASR) (Lyme ImmunoBlot IgG Strips Only)
04/01/2018
0043U
Tick-Borne Relapsing Fever Borrelia group, antibody detection to 4 recombinant protein groups, by immunoblot, IgM Tick-Borne Relapsing Fever Borrelia (TBRF) ImmunoBlots IgM Test IGeneX Inc ID-FISH Technology Inc. (Provides TBRF ImmunoBlot IgM Strips).
04/01/2018
0044U
Tick-Borne Relapsing Fever Borrelia group, antibody detection to 4 recombinant protein groups, by immunoblot, Tick-Borne Relapsing Fever Borrelia (TBRF) ImmunoBlots IgG Test IGeneX Inc ID-FISH Technology Inc. (Provides TBRF ImmunoBlot IgG Strips)
04/01/2018



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