2025 CPT code 87906
(Active) Effective Date: N/A Revision Date: N/A Pathology and Laboratory - Infectious Agent Genotype Analysis Pathology and Laboratory Procedures > Microbiology Procedures Feed
Analysis of HIV-1 genotype by nucleic acid, excluding reverse transcriptase and protease regions (e.g., integrase, fusion).
Modifiers 59 (distinct procedural service) and 91 (repeat procedure) are applicable under specific conditions as described in the CPT guidelines.
Medical necessity is established when there is evidence of virologic failure in an HIV-1 infected individual despite antiretroviral therapy. This necessitates further testing to guide treatment decisions and improve clinical outcomes. Documentation should include the patient's history, clinical presentation, and virological data supporting the need for 87906.
The clinical responsibility lies with the ordering physician who interprets the results to guide HIV treatment. The laboratory analyst performs the technical aspects of the test.
In simple words: This lab test analyzes the genetic makeup of the HIV-1 virus in a patient's blood sample. It examines specific parts of the virus's genes (not the reverse transcriptase and protease regions) to see if the virus is resistant to certain medications. This helps doctors choose the right drugs for the patient's HIV treatment.
This CPT code encompasses the analytical testing of the HIV-1 viral genotype using nucleic acid methods.The analysis focuses on regions of the viral genome other than the reverse transcriptase and protease regions; examples include the integrase or fusion genes.The procedure typically involves techniques like reverse transcriptase polymerase chain reaction (RT-PCR) and subsequent sequencing to identify mutations associated with drug resistance. The sample is typically patient serum. This test is often ordered when an HIV-positive patient demonstrates resistance to standard drug therapy.
Example 1: A patient with HIV-1 infection who is failing their current antiretroviral therapy undergoes 87906 testing to identify drug resistance mutations in the integrase gene., An HIV-1 positive pregnant woman receives 87906 testing to determine the appropriate antiretroviral regimen to prevent mother-to-child transmission., A patient with previously treated HIV-1 who is experiencing a viral load rebound undergoes 87906 testing to assess for resistance mutations in the fusion gene and guide treatment optimization.
** Always check payer-specific guidelines for coverage and reimbursement policies for this test.Some payers may have frequency limitations or require additional documentation to support medical necessity.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: Information not available in provided text.Consult current CPT manual and payer specific guidelines for RVU values.
- Global Days: Not applicable. This is a laboratory test, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Information not available in provided text.Consult historical CPT fee schedules for details.
- Specialties:Infectious Disease, Clinical Microbiology, Virology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Clinical Laboratory