2025 CPT code 4270F
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Performance Measurement - Therapeutic, Preventive or Other Interventions Category II Codes Feed
Patient receiving potent antiretroviral therapy for 6 months or longer (HIV).
Modifiers are not applicable to Category II codes.
The medical necessity for this code is to facilitate data collection and performance measurement of long-term HIV treatment.It helps assess the effectiveness of treatment strategies and improve care for patients with HIV.
The clinical responsibility lies with the physician managing the patient's HIV care, including monitoring the patient's response to therapy, managing side effects, and ensuring adherence to the medication regimen.
In simple words: This code is used to keep track of patients who have been taking strong HIV medicines for at least six months.It helps doctors and healthcare systems measure how well HIV treatment is working.
This Category II CPT code tracks patients receiving potent antiretroviral therapy (ART) for six months or more to monitor the effectiveness of HIV treatment and adherence to medication regimens.It is a supplemental tracking code used for performance measurement, not for reimbursement.
Example 1: A patient diagnosed with HIV initiates potent antiretroviral therapy. After six months of consistent treatment and viral load suppression, code 4270F is reported to track their long-term adherence and response to treatment., A patient with HIV, previously on a less effective regimen, switches to a potent antiretroviral therapy combination.Six months after the switch, code 4270F is used to monitor the efficacy of the new therapy and continued viral suppression., As part of a quality improvement initiative, a clinic tracks all HIV patients on potent ART for longer than six months using code 4270F to assess overall treatment success rates and identify areas for improvement in patient care.
Diagnosis of HIV infection.Documentation of the initiation date of potent antiretroviral therapy.Evidence of the patient receiving potent ART for six months or longer.This may include prescription records, pharmacy records, or medical notes indicating ongoing ART.Documentation of the type of antiretroviral therapy used.
** This code is optional and is not required for correct coding.It should be used in conjunction with other clinically relevant Category I codes for the actual services provided.
- RVU: This is a Category II code; it does not have a relative value unit.
- Global Days : Not applicable to Category II codes.
- Payment Status: Not reimbursable
- Modifier TC rule: Not applicable to Category II codes.
- Fee Schedule : Category II codes do not have fee schedules as they are not used for billing.
- Specialties:Infectious Disease, HIV/AIDS Specialists
- Place of Service:Office, Clinic, Hospital Inpatient, Hospital Outpatient