2025 CPT code 87904
Effective Date: N/A Revision Date: N/A 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; each additional drug tested.
Modifier 59 may be used for distinct procedural service and modifier 91 for repeat procedures on the same day.
Medical necessity is established by the patient's HIV-1 positive status and the need to determine drug resistance or choose an appropriate drug regimen.
The lab analyst performs all technical steps, including culturing the tissue specimen and analyzing the nucleic acids for drug resistance.
In simple words: This lab test analyzes a tissue sample from an HIV-1 positive patient to see how the virus reacts to different drugs.It helps determine which drugs will be most effective in treating the patient's infection. This code is used for each drug tested after the first 10.
This code represents an add-on procedure for each additional drug tested beyond the first 10 in an infectious agent phenotype analysis using nucleic acid with drug resistance tissue culture analysis for HIV 1.
Example 1: A patient with HIV-1 has developed resistance to their current drug regimen. A tissue sample is taken and analyzed against 15 different HIV-1 drugs to determine which ones are still effective. 87903 is reported for the first 10 drugs, and 87904 is reported five times for the additional drugs tested., A newly diagnosed HIV-1 patient has a tissue sample analyzed to determine the best course of treatment.The sample is tested against 12 different drugs. 87903 is reported for the first 10 drugs and 87904 is reported twice for the additional two drugs., A physician suspects that a patient's HIV-1 infection has developed multi-drug resistance. A tissue sample is tested against a panel of 20 drugs to identify effective treatment options. 87903 is reported along with 10 units of 87904 to represent all the drugs tested.
Documentation should include the patient's HIV-1 positive status, the reason for the test (e.g., drug resistance, initial treatment planning), a list of all drugs tested, and the results of the analysis.
- Revenue Code: T1H - LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE)
- Specialties:Infectious Disease, Pathology
- Place of Service:Independent Laboratory, Hospital, Outpatient Hospital