October 2026 Quarterly CLFS/CLIA Update
New Proprietary Lab Analysis Codes Added, 3 Codes Deleted, Effective October 1
Summary of the Rule or Edit Change
CMS issues a Clinical Laboratory Fee Schedule and CLIA update every quarter to keep the code set current with new genetic and molecular lab tests entering the market. The October 2026 cycle, released through CR 14569 on August 25, 2026, adds a round of new Proprietary Laboratory Analysis (PLA) codes and retires three: 0556U, 0557U and 0585U.
PLA codes are a distinct CPT category built for a specific manufacturer's or laboratory's proprietary test, rather than a generic method code any lab can bill. New PLA codes are typically contractor-priced when they first take effect, meaning each Medicare Administrative Contractor sets its own payment rate locally until CMS assigns a national price in a later update. That gap matters operationally: a lab billing a brand-new PLA code in Q4 2026 may see different reimbursement from different MACs for the same test until national pricing catches up.
The three deleted codes stop being valid for dates of service on or after October 1, 2026. Any claim still coded to 0556U, 0557U or 0585U after that date is coding to a retired code and should reject or deny, not get paid.
Action Required for Billing Teams
This is a narrow but concrete task: confirm your lab information system and claims scrubber no longer accept 0556U, 0557U or 0585U for October 2026 dates of service, and that any newly added PLA code your lab actually performs is loaded with the correct contractor-specific price.
The financial exposure here is specific to labs that run the exact tests tied to the deleted or newly added codes, so this isn't a sitewide revenue number worth estimating; it's a pass/fail check. A single claim billed on a deleted code after October 1 will deny outright, and a newly added PLA code billed at the wrong contractor rate either underpays your lab or risks an overpayment finding later.
- Remove the three deleted codes (0556U, 0557U, 0585U) from your charge master for October 1, 2026 dates of service forward.
- Confirm your MAC's contractor price for any newly added PLA code you actually bill, rather than assuming a default rate.
- Check held claims coded to the deleted codes with service dates at or after October 1 and recode them correctly if a replacement code exists.
- Watch for national pricing on the newly added codes in a future quarterly update, since contractor pricing is typically temporary.
Our laboratory billing guide and genetic and molecular testing billing guide cover how PLA codes fit into the broader lab billing picture.
Verifiable References
- Centers for Medicare & Medicaid Services / HHS. MM14569: Clinical Laboratory Fee Schedule & Clinical Laboratory Improvement Amendments (CLIA) Edits. hhs.gov/guidance/document/mm14569-clinical-laboratory-fee-schedule-clinical-laboratory-improvement-amendments-hcpcs
Related Resources
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