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The CPT® Code 87535 refers to the detection of the infectious agent HIV-1 through nucleic acid techniques, specifically utilizing an amplified probe technique. This method includes reverse transcription when performed, which is essential for converting RNA into DNA, allowing for the detection of the HIV-1 virus. The procedure is critical in identifying the presence of HIV-1, a virus that significantly impacts the immune system by targeting and destroying CD4 T-cells, which are vital for the body's defense against infections. HIV-1 is one of the two main serotypes of the Human Immunodeficiency Virus, the other being HIV-2. The transmission of HIV-1 can occur through various means, including sexual contact, sharing of needles, unscreened blood transfusions, and from mother to child during childbirth or breastfeeding. The identification of HIV-1 is crucial for timely intervention and management of the infection, as it can lead to Acquired Immunodeficiency Syndrome (AIDS) if left untreated. The testing process involves obtaining a blood sample, which is then subjected to amplification techniques to ensure that even low levels of the virus can be detected. This is particularly important as direct probe methods may not be sensitive enough for samples with minimal viral presence. The amplified probe technique enhances the likelihood of accurate detection, thereby facilitating appropriate clinical responses and treatment strategies.
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The procedure associated with CPT® Code 87535 is indicated for the detection of HIV-1 in patients who may be at risk for HIV infection or who exhibit symptoms consistent with HIV. The following conditions warrant the use of this testing method:
The procedure for CPT® Code 87535 involves several critical steps to ensure accurate detection of HIV-1 nucleic acids. The following procedural steps are outlined:
After the completion of the procedure associated with CPT® Code 87535, the patient may be advised on several post-procedure considerations. It is essential to communicate the results of the test to the patient, which may take some time depending on the laboratory's processing capabilities. If the test result is positive, further counseling and medical intervention will be necessary to discuss treatment options and management of the infection. Patients may also be advised to undergo regular follow-up testing to monitor their health status and the effectiveness of any treatment initiated. Additionally, it is important to provide education on preventive measures to reduce the risk of HIV transmission to others.
| Short Descr | HIV-1 PROBE&REVERSE TRNSCRPJ | Medium Descr | IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ | Long Descr | Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique, includes reverse transcription when performed | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 206 - Microscopic examination (bacterial smear, culture, toxicology) |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | GA | Waiver of liability statement issued as required by payer policy, individual case | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | GZ | Item or service expected to be denied as not reasonable and necessary | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2014-01-01 | Changed | Description Changed |
| 2013-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Short description changed. |
| 1998-01-01 | Added | First appearance in code book in 1998. |
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