2025 CPT code 87903
(Active) Effective Date: N/A Revision Date: N/A Pathology and Laboratory Procedures - Microbiology Procedures Pathology and Laboratory Procedures > Microbiology Procedures Feed
Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through 10 drugs tested.
Modifiers 91 (repeat test) and 59 (multiple specimens/sites) are applicable.Other modifiers may apply depending on the specific circumstances of service.
This test is medically necessary when there is evidence of treatment failure (e.g., increased viral load, clinical deterioration) in patients with HIV-1, and this information is critical in modifying their drug regimen to maintain or restore virologic suppression. The results directly impact treatment decisions, enhancing patient outcomes and preventing further disease progression.
The lab analyst performs all technical steps, including culturing the tissue specimen, exposing it to drug samples, and analyzing the growth of the HIV-1 virus to determine drug resistance.
In simple words: A lab test analyzes a tissue sample from someone with HIV to see which HIV drugs work against their particular type of virus.The test checks how the virus reacts to up to ten different drugs to help doctors choose the best medicines for treatment.
This CPT code encompasses the laboratory analysis of nucleic acids (DNA or RNA) from a tissue sample of an HIV-1 positive patient to determine drug resistance through tissue culture analysis.The analysis covers up to the first ten drugs tested.The procedure involves culturing the tissue sample on a suitable medium to allow HIV-1 viral growth, followed by exposure to various drug samples to assess the reaction.Resistance is indicated by unaffected viral growth in the presence of a particular drug, while sensitivity is indicated by inhibited viral growth. This test aids in determining optimal drug regimens for HIV-1 patients or adjusting regimens when current treatment is ineffective.
Example 1: A patient with HIV-1 is experiencing treatment failure.This test is ordered to identify the specific drug resistance patterns present in their viral load to guide the clinician in selecting a new treatment regimen., Prior to initiating HIV-1 treatment, this test may be used to inform the selection of an initial drug regimen based on existing resistance patterns within the patient’s viral load. This would assist in preventing treatment failure from the outset., A patient on combination antiretroviral therapy (cART) shows a rise in viral load, suggesting resistance. The test is performed to clarify specific resistance patterns to aid in switching to an alternate, more effective cART regimen.
* Patient's HIV-1 diagnosis confirmation.* Detailed history of prior antiretroviral therapy, including drug names, dosages, and durations.* Viral load testing results showing treatment failure or a rise in viral load.* Complete clinical details describing the reasons for the testing and the clinical indication of this procedure.* Properly labeled and identified tissue sample for accurate processing and identification.* Report detailing the specific drugs tested and the resulting resistance profile.
** This code is specifically for HIV-1 drug resistance testing.Other infectious agents would require different codes.Results should be interpreted by a qualified clinician experienced in HIV management.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Infectious Disease, Clinical Microbiology, Virology
- Place of Service:Laboratory