Billing & Coding: MAAA Coding 101

The advent of new technology has led to the development of multianalyte assays with algorithmic analyses (MAAA) tests that leverage results from a panel of lab tests to generate a risk or probability score. The American Medical Association (AMA) has developed special MAAA codes that labs should use to bill for these tests. Here’s a quick briefing of what labs and billing managers need to know about MAAA coding for tests based on molecular platforms.

What MAAAs Are

As Current Procedural Terminology (CPT) explains, MAAAs are procedures that utilize multiple results derived from panels of analyses of various types, including molecular pathology assays, fluorescent in situ hybridization assays, and non-nucleic acid-based assays, including proteins, polypeptides, lipids, and carbohydrates. Analysis of the test results, which may or may not be combined with other clinical information about the patient, is reported as a numeric score(s) of risk or probability.

Because the algorithmic formulas the tests are based on tend to be proprietary in nature, particular MAAAs are typically unique to a single clinical laboratory or manufacturer, often in the form of a laboratory developed test (LDT). To be listed with a MAAA code, the procedure/panel must be generally available for patient care.

The MAAA Codes

The AMA instructs that the MAAA procedure codes encompass all analytical services required for the algorithmic analysis (e.g., cell lysis, nucleic acid stabilization, extraction, digestion, amplification, hybridization, and detection) in addition to the algorithmic analysis itself. Procedures that are required prior to cell lysis (e.g., microdissection codes 88380 and 88381) may be reported separately.

CPT also indicates that to report a MAAA code, “the analysis performed must fulfill the code descriptor” and, if proprietary, “must be the test represented by the proprietary name listed in Appendix O.” If a specific MAAA procedure is not listed in the MAAA section of CPT or Appendix O, “the procedure must be reported using the Category I MAAA unlisted code (81599).”¹

CPT	Description
81599	Unlisted multianalyte assays with algorithmic analyses

Note that there are two categories of MAAA procedure codes:

• Category I codes, which are 5-digit numerical codes in the 815XX section of CPT;
• Administrative codes, which are four-digit alphanumeric codes ending with the letter M.

These codes are listed in the Clinical Laboratory Fee Schedule (CLFS). If an allowable has been identified, it will also be listed.

Examples of current MAAA codes include:

CPT	Description
81542	Oncology (prostate), mRNA, microarray gene expression profiling of 22 content genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as metastasis risk score (Decipher® Prostate, Decipher Biosciences)
81551	Oncology (prostate), promoter methylation profiling by real-time PCR of 3 genes (GSTP1, APC, RASSF1), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a likelihood of prostate cancer detection on repeat biopsy (ConfirmMDx® for Prostate Cancer, MDxHealth, Inc.)
0011M	Oncology, prostate cancer, mRNA expression assay of 12 genes (10 content and 2 housekeeping), RT-PCR test utilizing blood plasma and urine, algorithms to predict high-grade prostate cancer risk (NeoLAB™ Prostate Liquid Biopsy, NeoGenomics Laboratories)

Proprietary Laboratory Analyses (PLA) Codes for MAAAs

In 2018, the AMA added a new CPT subsection listing PLA codes for tests recognized under PAMA (the Protecting Access to Medicare Act of 2014), including advanced diagnostic laboratory tests (ADLTs) and clinical diagnostic laboratory tests (CDLTs). These analyses may include a range of medical laboratory tests, including but not limited to, MAAAs and genomic sequencing procedures (GSP). Where possible, the descriptor nomenclature follows existing code conventions, e.g., those relating to MAAA, GSP.

These codes are not required to fulfill the Category I criteria. The standards for inclusion in the PLA section of CPT are:

• The test must be commercially available in the United States for use on human specimens; and
• The clinical laboratory or manufacturer that offers the test must request the code.

When a PLA code is available to report a given proprietary laboratory service, that PLA code takes precedence. The service should not be reported with any other CPT code(s); nor should other CPT code(s) be used to report services that may be reported with that specific PLA code.

As with MAAA codes, the PLA codes encompass all analytical services required for the analysis (e.g., cell lysis, nucleic acid stabilization, extraction, digestion, amplification, hybridization, and detection). Codes in this subsection are released on a quarterly basis to expedite dissemination for reporting. PLA codes are published electronically on the AMA CPT website, distributed via CPT data files on a quarterly basis, and, at a minimum, made available in print annually in the CPT codebook.² To exemplify their necessity and popularity, compare 18 codes that were initially assigned in 2018 to the 345 codes listed in the 2023 codebook.

To report a PLA code, the analysis performed must fulfill the PLA code descriptor and must be the test represented by the proprietary name listed in the document that published to the AMA CPT website or Appendix O.

As with MAAA codes, PLA codes are listed in the CLFS; if an allowable has been identified, it will be listed. Examples of current PLA codes for MAAA products:

CPT	Description
0005U	Oncology (prostate) gene expression profile by real-time PCR of 3 genes (ERG, PCA3, and SPDEF), urine, algorithm reported as risk score (ExosomeDx® Prostate (IntelliScore), Exosome Diagnostics, Inc.)
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 CDx™ (F1CDx), Foundation Medicine, Inc.)
0053U	Oncology (prostate cancer), FISH analysis of 4 genes (ASAP1, HDAC9, CHD1, and PTEN), needle biopsy specimen, algorithm reported as probability of higher tumor grade (Prostate Cancer Risk Panel, Mayo Clinic, Laboratory Developed Test)

MAAA and PLA codes provide a mechanism to assign codes to complex procedures that could not previously be aligned to Category 1 codes other than those that are unlisted. Without these codes, most of the above examples would require stacking of codes, leading to the perception of excess coding. And, there would still be procedural components that may not have pertinent codes. Use of these codes provides transparency. They readily identify the testing performed and whether such testing is covered for payment.

References:

1. https://www.ama-assn.org/system/files/cpt-pla-codes-long.pdf
2. https://www.ama-assn.org/practice-management/cpt/cpt-pla-codes

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Diana W. Voorhees, M.A., CLS, MT, SH, CLCP, CPCO, is principal in DV & Associates, Inc., Salt Lake City, UT, which makes no representation, guarantee or warranty, expressed or implied, that the information provided is free of error, and will bear no responsibility or liability for results or consequences of its use.