CPT® PLA Code Changes for October 2025: Key Changes for Providers and Billing Teams

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As of October 1, 2025, the American Medical Association (AMA) CPT® Editorial Panel has released its latest set of Proprietary Laboratory Analyses (PLA) code changes. The update includes 25 new PLA codes, two deletions, and one revision. In addition, one code has a manufacturer change, reflecting the continued evolution of precision medicine and the diagnostic testing industry.

Understanding these changes is essential for laboratories, physicians, coders, and billing professionals to ensure accurate reporting, reimbursement compliance, and smooth revenue cycle management.

What Are PLA Codes and Why Do They Matter?

Proprietary Laboratory Analyses (PLA) codes are CPT® codes that describe unique, proprietary clinical laboratory tests. These tests can be developed and performed by a single laboratory (“sole-source”) or licensed/marketed to multiple laboratories, often with FDA clearance or approval.

PLA codes were introduced to:

• Provide greater transparency in reporting proprietary tests.
• Ensure proper tracking and reimbursement by payors.
• Support accurate claims processing and distinguish between general laboratory services and proprietary ones.

These codes cover a wide variety of advanced diagnostic laboratory tests (ADLTs) and clinical diagnostic laboratory tests (CDLTs), ranging from oncology and neurology to infectious disease and transplant monitoring.

Key Highlights from the October 2025 PLA Code Update

1. One Revised PLA Code

The only revised PLA code in this cycle is:

• 0333U – Oncology (liver) surveillance.

The proprietary name and manufacturer are updated to reflect HelioLiver™ Test by Helio Genomics®.

This ensures accurate attribution to the specific proprietary test and provider.

2. Two Deleted PLA Codes

The following codes have been removed effective October 1, 2025:

• 0450U – Oncology (multiple myeloma), LC-MS/MS monoclonal paraprotein sequencing analysis.
• 0451U – Oncology (multiple myeloma), LC-MS/MS peptide ion quantification.

Both codes focused on multiple myeloma monitoring but are no longer recognized in the CPT® code set. This means providers will need to adjust their coding and billing practices accordingly.

3. Twenty-Five New PLA Codes

The bulk of the update introduces 25 new PLA codes, reflecting rapid advancements in oncology diagnostics, genetic sequencing, infectious disease testing, neurology, and transplant monitoring.

Some notable additions include:

• 0575U & 0576U – Liver transplant monitoring using next-generation biomarkers (HepatoTrack™ and OmniGraf® Liver).
• 0577U – Ovarian cancer detection via serum glycoproteomic signatures (GlycoKnow™ Ovarian).
• 0582U & 0583U – Rapid whole genome sequencing tests for rare diseases (Mayo Clinic).
• 0584U – Prion disease detection using RT-QuIC technology.
• 0591U – Prostate cancer test (MiCheck® Prostate).
• 0596U – Alzheimer’s disease risk biomarker analysis (Precivity-ApoE™).
• 0599U – Pancreatic cancer test (PancreaSure™).

These additions highlight the growing integration of genomics, precision oncology, and advanced infectious disease panels into mainstream clinical practice.

Why These Changes Matter for Providers and Billing Teams

Accurate coding of proprietary tests is critical for:

• Reimbursement Compliance – Payers require the correct PLA code to process claims and determine coverage.
• Revenue Integrity – Using outdated or deleted codes can result in denials, delayed payments, or compliance risks.
• Clinical Documentation – PLA codes ensure that a proprietary test is clearly identified, supporting medical necessity and prior authorization processes.
• Patient Access – Correct use of PLA codes can reduce delays in patient care by streamlining approvals.

Preparing for CPT® PLA Code Changes

To stay ahead of these updates, practices, labs, and billing teams should:

• Update internal coding systems and EHRs with the latest PLA code changes.
• Educate coders and billing staff on new, revised, and deleted codes.
• Communicate with payors to confirm coverage policies for new proprietary tests.
• Audit claims regularly to avoid denials from outdated or incorrect code usage.

In Conclusion

The October 1, 2025 PLA code updates reflect the rapid pace of innovation in laboratory testing, especially in oncology, rare diseases, neurology, and infectious disease management. For healthcare organizations, understanding and implementing these updates is critical to ensure accurate billing, streamlined reimbursement, and uninterrupted patient care.

As PLA codes continue to expand alongside precision medicine, providers and revenue cycle teams must remain proactive in adapting to these changes.

Partner with Experts to Navigate Coding Changes

The continuous evolution of CPT® PLA codes demonstrates how quickly the diagnostic landscape is advancing. While these updates create exciting opportunities for patient care, they also introduce challenges for practices and hospitals trying to keep pace with ever-changing coding requirements. Even a small coding error can lead to claim denials, delayed reimbursements, or compliance risks.

That’s where we come in. Our team of certified medical coders specializes in staying current with the latest CPT®, ICD-10, and HCPCS updates, including PLA code changes. We help practices, laboratories, and hospitals ensure accurate coding, streamlined claims submission, and maximum reimbursement—all while maintaining compliance with payor requirements and regulatory standards.

By outsourcing your coding needs to us, your organization can:

• Eliminate coding errors that lead to costly denials.
• Stay compliant with new and revised CPT® and PLA codes.
• Free up internal staff to focus on patient care.
• Optimize revenue cycle performance with expert-driven RCM solutions.

If your practice or hospital is looking for a reliable partner to handle complex coding challenges, our team is here to help you navigate every update with confidence.

Schedule a free consultation and practice audit today! (or) Click the link to explore our medical coding services in detail.