2025 CPT code 87901
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Microbiology Procedures Pathology and Laboratory Procedures Feed
Analysis of HIV-1 reverse transcriptase and protease regions by nucleic acid (DNA or RNA).
Modifiers 59 (distinct procedural service) and 91 (repeat procedure) may be applicable.
Medical necessity for 87901 is established when there is a clinical indication for evaluating HIV-1 drug resistance, such as treatment failure, pre-treatment risk assessment, or suspected viral rebound.Specific payer policies should be referenced for further details.
A clinical laboratory scientist or technician performs the technical aspects of the test. A physician interprets the results and integrates them into patient care.
In simple words: This lab test checks the genetic makeup of the HIV-1 virus in a person's blood. It looks at specific parts of the virus's genes that affect how well medicine works against it.The results help doctors choose the best medication for that person's HIV infection.
This CPT code encompasses the laboratory analysis of a patient specimen (typically serum) from an HIV-1 positive individual to determine the genotype of the virus, specifically focusing on the reverse transcriptase and protease regions.The process often involves techniques like polymerase chain reaction (PCR) to amplify the viral nucleic acid, followed by the use of nucleic acid probes to identify the specific genotype. This detailed genetic analysis is crucial for guiding antiretroviral therapy, as variations in these regions can lead to drug resistance. The results help clinicians select the most effective treatment regimen.
Example 1: A patient with HIV-1 is experiencing treatment failure despite adhering to their prescribed antiretroviral therapy. 87901 is ordered to identify mutations in the reverse transcriptase and protease genes, aiding in selecting a new drug regimen., Before initiating antiretroviral therapy in a newly diagnosed HIV-1 positive patient, 87901 is used for baseline genotyping to predict potential resistance to certain drugs and guide initial treatment selection., A patient with HIV-1 shows signs of viral rebound while on antiretroviral therapy.87901 is performed to determine if drug resistance mutations have developed, necessitating a change in treatment strategy.
* Patient's demographic information* HIV-1 positive diagnosis confirmation* Details of current and prior antiretroviral therapy* Indication for testing (e.g., treatment failure, pre-treatment evaluation)* Laboratory report with complete genotype results* Physician's order specifying the test
** This test should be interpreted by a qualified physician.The results should be considered in conjunction with other clinical data to make informed treatment decisions. Results may influence decisions about medication regimens and treatment outcomes for HIV-1 infection.Specific methodologies used by individual laboratories may vary, but the overall clinical interpretation remains consistent.
- Revenue Code: T1H (LAB TESTS - OTHER)
- RVU: Information not available.RVUs vary based on geographic location and payer.
- Global Days: Not applicable. This is a laboratory test, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable for this laboratory test.
- Fee Schedule: Information not available. Historical fee schedules will vary depending on payer and geographic location.
- Specialties:Infectious Disease, Clinical Microbiology, Internal Medicine
- Place of Service:Office, Hospital (inpatient/outpatient), Clinical Laboratory