2027 Pathology and Laboratory Coding Updates

Molecular Tests, PLA Changes, Documentation and CLFS Risk

Pathology and laboratory coding continues to change rapidly as molecular testing, genomic analysis, infectious-disease diagnostics, algorithmic services and proprietary assays evolve.

Laboratories must determine whether a service is reported with an established Category I code, a Proprietary Laboratory Analyses code, another specialized code or an unlisted procedure. Because certain laboratory and PLA codes may follow quarterly release schedules, maintaining accurate systems requires more than a once-a-year update.

The coding transition also intersects with Medicare payment policy. CMS has proposed changes affecting Clinical Laboratory Fee Schedule data collection and reporting, along with the phase-in of payment reductions beginning in 2027. These payment-policy proposals are separate from CPT® coding changes, but together they create significant financial and operational concerns for laboratories.

Session Agenda

• Important 2027 pathology and laboratory code changes
• Molecular pathology and genomic-testing updates
• Proprietary Laboratory Analyses additions, revisions and deletions
• Coding considerations for infectious-disease testing
• Selecting between Category I, PLA and unlisted reporting pathways
• Test methodology, analyte and specimen documentation requirements
• Medical-necessity and diagnosis-support considerations
• MolDX, Medicare Administrative Contractor and payer-policy checkpoints
• Frequency limitations and coverage-related denial risks
• Maintaining code tables when quarterly laboratory updates occur
• CMS-proposed 2027 CLFS data-reporting and payment changes
• Separating correct coding from coverage and reimbursement determinations

Session Objectives

At the conclusion of this webinar, participants will be able to:

• Identify important 2027 pathology and laboratory coding developments.
• Understand coding considerations for molecular and genomic testing.
• Distinguish between Category I, PLA, specialized and unlisted laboratory codes.
• Determine when a PLA code may be appropriate for a proprietary laboratory analysis.
• Recognize circumstances requiring specialized or unlisted procedure reporting.
• Apply appropriate coding concepts to infectious-disease diagnostic services.
• Understand reporting considerations for algorithmic laboratory services.
• Identify documentation elements needed to support complex laboratory testing.
• Explain why PLA and other laboratory-code updates may require monitoring beyond the annual CPT® update.
• Understand key Clinical Laboratory Fee Schedule (CLFS) policy considerations.

Session Highlights

• 2027 Pathology & Laboratory coding updates
• Molecular and genomic testing considerations
• Infectious-disease diagnostic coding
• Algorithmic laboratory services
• PLA (Proprietary Laboratory Analyses) codes
• Category I vs. PLA vs. unlisted codes
• When specialized laboratory codes may apply
• Appropriate use of unlisted procedure reporting
• Documentation requirements for molecular and proprietary testing
• Managing quarterly PLA releases and updates
• Keeping laboratory coding systems current throughout the year
• Clinical Laboratory Fee Schedule (CLFS) considerations

Who Should Attend

This boot camp is recommended for:

• Certified professional coders
• Specialty coders and coding managers
• Medical billers and reimbursement professionals
• Revenue-cycle directors and managers
• Physicians and nonphysician practitioners
• OB-GYN and maternity-care practices
• Radiology and interventional-radiology groups
• General surgeons and surgical practices
• Pathology groups and clinical laboratories
• Hospital outpatient departments
• Ambulatory surgery centers
• Clinical documentation improvement professionals
• Compliance officers and internal auditors
• Practice managers and administrators
• Charge-capture and charge-master teams
• EHR, coding-system and workflow implementation teams
• Consultants and provider educators