Navigating April OPPS updates: HCPCS coding for PLA services, COVID-19 testing

Why This Topic Matters

These updates affect how hospitals and laboratories report certain diagnostic services under Medicare and related payment systems. The article is useful for coders, billers, compliance staff, and laboratory operations teams tracking current OPPS and HCPCS/CPT changes.

Article Sections

1. Updates to PLA codes

   This section introduces the April proprietary laboratory analysis update and places it in the context of the CPT code set, quarterly release cycles, and Medicare-related reporting guidance. It also lists the newly added PLA identifiers referenced in the article.

2. COVID-19 testing

   This section discusses the April OPPS context for COVID-19 testing, including CDC classification concepts, evolving reporting considerations, and the connection to ICD-10-CM and inpatient payment issues. It also sets up the later HCPCS and CPT coding discussion for laboratory testing.

3. HCPCS coding

   This section covers the HCPCS and CPT laboratory testing codes associated with COVID-19 diagnostics, along with the article’s discussion of claims processing, OPPS status, and fee schedule handling. It also notes timing and pricing considerations mentioned in the update.