May Industry Notes: PLA Code Changes July 1, 2025

PLA codes, 0240U and 0241U, will be deleted by the AMA with an effective date of July 1, 2025. CPT Code 87636 will replace the Proprietary Lab Analysis Code (PLA) 0240U and CPT Code 87637 will replace PLA Code 0241U.  

CPT Code 87636 and CPT Code 87637 are established codes covered and reimbursed by most payers for applicable respiratory pathogen panel tests.     

There are no differences in the Centers for Medicare and Medicaid Services (CMS) Clinical Laboratory Fee Schedule (CLFS) rates between the PLA codes that are being deleted (0240U and 0241U) and the Category 1 CPT codes (87636 and 87637) that should be used starting July 1, 2025. All have the same CLFS reimbursement rate of $142.63.1 This rate is specific to Medicare. Medicaid and Commercial payer rates may vary.  

Please see the CPT code descriptors below: 

CPT Code 87636: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique 

CPT Code 87637: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique