2025 CPT code 87900
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Microbiology Procedures Pathology and Laboratory Procedures Feed
Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics.
Modifiers 59 and 91 are applicable as per CPT guidelines.
Medical necessity is established when a patient shows an inadequate response to standard antiviral therapy, or if the viral load is high enough to warrant more targeted therapy (generally, above 500).Payers may have specific criteria.
The lab analyst performs all technical steps, including the phenotype prediction using updated bioinformatics. The clinician uses the results to guide treatment decisions.
In simple words: This lab test checks how well a virus responds to different antiviral medications. The test uses computer analysis of the virus's genetic makeup to predict which drugs will be most effective, helping doctors choose the right treatment.
This CPT code reports infectious agent drug susceptibility phenotype prediction.The prediction is generated using regularly updated genotypic bioinformatics, comparing patient data to a large database to determine susceptibility or resistance to antiviral drugs.This aids clinicians in selecting appropriate drug regimens.
Example 1: A patient with HIV on a multidrug regimen shows no improvement in viral load.Code 87900 is used to predict drug susceptibility to optimize therapy., An HIV-positive pregnant woman requires drug susceptibility testing to ensure safe and effective treatment during pregnancy. Code 87900 is utilized., A patient presents with a resistant viral infection, and 87900 is used to determine appropriate treatment options, aiding in selecting effective antiviral drugs.
Patient demographics, HIV diagnosis confirmation, viral load measurement, details of current antiviral regimen,results of the drug susceptibility test, and interpretation by the laboratory.
** This code is primarily used for HIV-1, but can be applied to other infectious agents. Always refer to the most current CPT codebook for the latest guidelines and updates.Payers may have specific requirements regarding prior authorization, frequency limitations, or documentation needs.Check with individual payers for their specific policies.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: This information is not available in the provided text.Consult the current CPT codebook and local payer guidelines for RVU values.
- Global Days: Not applicable; this is a laboratory test.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: This information is not available in the provided text.Consult the current CPT codebook and local payer guidelines for historical fee schedules.
- Specialties:Infectious Disease, Virology, Clinical Microbiology, HIV/AIDS
- Place of Service:Laboratory