Requires the fee schedule for appropriate current procedural terminology and proprietary laboratory analysis codes be regularly updated for all mandatory…

◆ The sponsor's argument

Why Roxanne J. Persaud says this is needed

This bill requires the New York State Medicaid program to recognize and adopt both Current Procedural Terminology (CPT) and Proprietary Labora- tory Analyses (PLA) codes by the American Medical Association on its fee schedule for biomarker testing and advanced molecular diagnostics. The majority of states that have enacted biomarker testing coverage laws utilize PLA codes when applicable alongside CPT codes as a best practice to support accurate reimbursement, transparency, and patient access to precision medicine. Biomarker testing is one of the most important tools in modem medicine, allowing physicians to determine whether patients are likely to benefit from targeted therapies, immunotherapy, or other personalized treat- ments. However, many advanced biomarker tests are still billed using generic laboratory codes that do not identify the specific test being performed. This creates challenges for payers, providers, and patients alike. Without precise coding, insurers often cannot determine which test was utilized or whether it aligns with clinical guidelines, resulting in delays, additional documentation requests, and denials of medically necessary testing. Patients and physicians ultimately bear the conse- quences of these inefficiencies. PLA codes, approved by the American Medical Association, provide unique identifiers for specific diagnostic tests and establish greater clarity in claims processing and reimbursement. Adoption of PLA codes improves transparency, reduces administrative burdens, strengthens oversight of pricing and utilization, and helps ensure patients receive timely access to the diagnostic information needed to guide appropriate treatment decisions. Precision medicine depends on precision diagnostics, and precision diag- nostics require precision coding and pricing. Recognizing PLA codes within the Medicaid fee schedule is a necessary step to modernize reimbursement policy and ensure equitable access to precision medicine for New York patients

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.