2025 CPT code 87390
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Infectious Agent Antigen Detection Pathology and Laboratory Procedures > Microbiology Procedures Feed
Qualitative or semiquantitative immunoassay to detect HIV-1 antigens.
Modifiers 59 (distinct procedural service) and 91 (repeat clinical diagnostic laboratory test) may be applicable under specific circumstances. Refer to the CPT manual and payer guidelines for appropriate modifier usage.
Medical necessity is established by the physician's clinical judgment based on the patient's risk factors (e.g., sexual history, intravenous drug use, exposure to HIV-infected blood), symptoms, or as part of routine screening guidelines.Payers have specific medical necessity guidelines that should be reviewed for compliance.
The clinical responsibility lies with the physician who orders the test.The laboratory is responsible for the technical aspects of performing the test and reporting the results.
In simple words: This lab test checks for HIV-1 in a blood sample using a special technique.A positive result needs to be confirmed with another test before a diagnosis of HIV can be made. This test can help find HIV early, track how the infection is progressing, and see if treatment is working.
This CPT code represents the qualitative or semiquantitative detection of HIV-1 antigens using an immunoassay technique (e.g., EIA, ELISA, FIA, IMCA) on a primary specimen (serum, plasma).The test assesses the presence of HIV-1 antigens, such as p24, indicating circulating, replicating virus.This is not a standalone diagnostic test and requires confirmation for positive results.The test may be used to detect early HIV-1 infection, monitor disease progression, or assess treatment response.
Example 1: A patient presents with flu-like symptoms and a history of risky sexual behavior. The physician orders this test as part of an initial HIV screening., A patient diagnosed with HIV is undergoing treatment.The physician orders this test to monitor viral load and assess the effectiveness of antiretroviral therapy., A pregnant woman undergoes routine HIV testing as part of prenatal care. The results will guide decisions regarding preventative treatment for the mother and the infant.
Patient demographics, date of service, specimen type (serum, plasma), test results (qualitative/semiquantitative), and the method used for the immunoassay.If positive, documentation supporting medical necessity for confirmatory testing is required.
** Always refer to the most current CPT and payer guidelines for accurate coding and billing.This information is for educational purposes only and should not be considered medical or legal advice.
- Revenue Code: T1H (LAB TESTS - OTHER)
- RVU: Refer to the CMS Clinical Laboratory Fee Schedule for current relative value units and reimbursement rates.RVUs will vary based on geographic location and other factors.
- Global Days: Not applicable.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data can be obtained from CMS and private payers' websites.Note that reimbursement rates fluctuate based on various factors.
- Specialties:Infectious Disease, Internal Medicine, Family Medicine, OB/GYN
- Place of Service:Office, Hospital, Laboratory, other appropriate settings