CMS Adds New PLA Oncology, ELISA, Reproductive Codes to HCPCS
CMS added seven new PLA codes to the HCPCS files, effective July 1, 2021, which will be contractor-priced based on local rates until they undergo the CLFS annual payment determination process for national pricing. Laboratory CPT Code Long Descriptor Short Descriptor TOS 3D Predict Glioma, KIYATEC, Inc 0248U Oncology (brain), spheroid cell culture in a 3D microenvironment, 12 drug panel, tumor-response prediction for each drug ONC BRN SPHRD CLL 12 RX PNL 5 Theralink Reverse Phase Protein Array (RPPA), TheralinkTechnologies, Inc, Theralink Technologies, Inc 0249U Oncology (breast), semiquantitative analysis of 32 phosphoproteins and protein analytes, includes laser capture microdissection, with algorithmic analysis and interpretative report ONC BRST ALYS 32 PHSPRTN ALG 5 PGDx elioTM tissue complete, Personal Genome Diagnostics, Inc, Personal Genome Diagnostics, Inc 0250U Oncology (solid organ neoplasm), targeted genomic sequence DNA analysis of 505 genes, interrogation for somatic alterations (SNVs [single nucleotide variant], small insertions and deletions, one amplification, and four translocations), microsatellite instability and tumor-mutation burden ONC SLD ORG NEO DNA 505 GENE 5 Intrinsic Hepcidi IDxTM Test, IntrinsicDx, Intrinsic LifeSciencesTM LLC 0251U Hepcidin-25, enzyme-linked immunosorbent assay (ELISA), serum or plasma HEPCIDIN-25 ELISA SERUM/PLSM 5 POC (Products of Conception), Igenomix, Igenomix USA 0252U Fetal aneuploidy short tandem–repeat […]
CMS added seven new PLA codes to the HCPCS files, effective July 1, 2021, which will be contractor-priced based on local rates until they undergo the CLFS annual payment determination process for national pricing.
| Laboratory | CPT Code | Long Descriptor | Short Descriptor | TOS |
| 3D Predict Glioma, KIYATEC, Inc | 0248U | Oncology (brain), spheroid cell culture in a 3D microenvironment, 12 drug panel, tumor-response prediction for each drug | ONC BRN SPHRD CLL 12 RX PNL | 5 |
| Theralink Reverse Phase Protein Array (RPPA), TheralinkTechnologies, Inc, Theralink Technologies, Inc | 0249U | Oncology (breast), semiquantitative analysis of 32 phosphoproteins and protein analytes, includes laser capture microdissection, with algorithmic analysis and interpretative report | ONC BRST ALYS 32 PHSPRTN ALG | 5 |
| PGDx elioTM tissue complete, Personal
Genome Diagnostics, Inc, Personal Genome Diagnostics, Inc |
0250U | Oncology (solid organ neoplasm), targeted genomic sequence DNA analysis of 505 genes, interrogation for
somatic alterations (SNVs [single nucleotide variant], small insertions and deletions, one amplification, and four translocations), microsatellite instability and tumor-mutation burden |
ONC SLD ORG NEO DNA 505 GENE | 5 |
| Intrinsic Hepcidi IDxTM Test, IntrinsicDx,
Intrinsic LifeSciencesTM LLC |
0251U | Hepcidin-25, enzyme-linked immunosorbent assay (ELISA), serum or plasma | HEPCIDIN-25 ELISA SERUM/PLSM | 5 |
| POC (Products of Conception), Igenomix,
Igenomix USA |
0252U | Fetal aneuploidy short tandem–repeat comparative analysis, fetal DNA from products of conception, reported as normal (euploidy), monosomy, trisomy, or partial deletion/duplications, mosaicism, and segmental aneuploidy | FTL ANEUPLOIDY STR ALYS DNA | 5 |
| ERA (Endometrial Receptivity Analysis),
Igenomix, Igenomix USA |
0253U | Reproductive medicine (endometrial receptivity analysis), RNA gene expression profile, 238 genes by next generation sequencing, endometrial tissue, predictive algorithm reported as endometrial window of implantation (e.g., pre-receptive, receptive, post-receptive) | RPRDTVE MED RNA GEN PRFL 238 | 5 |
| SMART PGT-A (Preimplantation Genetic
Testing – Aneuploidy), Igenomix, Igenomix USA |
0254U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using embryonic DNA genomic sequence analysis for aneuploidy, and a mitochondrial DNA score in euploid embryos, results reported as normal (euploidy), monosomy, trisomy, or partial deletion/duplications, mosaicism, and segmental
aneuploidy, per embryo tested |
REPRDTVE MED ALYS 24 CHRMSM | 5 |
CMS also added CPT Code G0327, Colorectal cancer screening; blood-based biomarker (Colon ca scm;bld-bsd biomark) to the national HCPCS file, effective July 1.
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