PLA Codes or CPT codes

can anyone tell me which code and why, you would try to obtain if you were a startup that has an fda approved dx test?

 

In general, if the assay is same/similar to existing assays and there is an existing CPT code for your assay - that is what you will go with. But, the Proprietary Laboratory Analyses (PLA) code method is for LDT or cleared assays that don't fit into the normal code system or stack of codes. The 'proprietary' part of the schema is relevant in many of the ~80 assays now with PLA codes. Typically an assay with a unique method or interpretation that has value the lab wants to extract. Note that the PLA code now makes it identifiable in the payor system and you might get your reimbursement, or you might get locked out and Medical Policy applied at a zero amount.