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The CPT® Code 87901 refers to the process of conducting an infectious agent genotype analysis specifically for the HIV-1 virus. This analysis focuses on the reverse transcriptase and protease regions of the virus's genetic material, which is either DNA or RNA. The primary purpose of this test is to identify mutations within the HIV-1 genes that may lead to resistance against 19 commonly prescribed medications known as reverse transcriptase and protease inhibitors. These medications are critical in the treatment of HIV-1, a virus that significantly compromises the immune system by targeting and destroying T cells, also known as CD4 cells, which are essential for the body's ability to combat infections. HIV is the causative agent of acquired immunodeficiency syndrome (AIDS), which represents the most advanced stage of HIV infection. As an RNA virus, HIV has a high replication rate, and the reverse transcription process necessary for its replication can introduce mutations into its genetic code. Some of these mutations can result in the virus developing resistance to antiviral drugs, making treatment less effective. To combat this, initial treatment for HIV typically involves a combination of antiretroviral medications that work through various mechanisms to lower the viral load and minimize the risk of mutations that lead to drug resistance. This approach is known as highly active antiretroviral therapy (HAART). However, when the initial treatment fails, a genotype analysis is performed to assess the reverse transcriptase and protease genes for known mutations associated with drug resistance. The genotyping process is intricate and requires a blood sample to evaluate the presence of specific nucleic acid sequences associated with HIV-1. The procedure involves three main steps: first, the amplification of specific nucleic acid sequences using techniques such as polymerase chain reaction (PCR); second, the purification of the amplified product followed by further molecular analysis; and finally, the comparison of the amplified sequences to established sequences that are known to confer drug resistance. The results of this analysis are crucial for developing a more effective drug regimen tailored to better control the HIV infection.
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The CPT® Code 87901 is indicated for use in specific clinical scenarios related to the management of HIV-1 infection. The following conditions warrant the performance of this genotype analysis:
The procedure for conducting the genotype analysis under CPT® Code 87901 involves several detailed steps to ensure accurate results. Each step is crucial for the successful identification of mutations in the HIV-1 virus:
Following the completion of the genotype analysis, healthcare providers will review the results to determine the presence of any mutations that confer drug resistance. This information is critical for guiding future treatment decisions. Patients may require adjustments to their antiretroviral therapy based on the findings, which could involve switching to alternative medications that are more effective against the identified strain of HIV-1. Additionally, ongoing monitoring and follow-up testing may be necessary to assess the effectiveness of the new treatment regimen and to ensure that the virus remains under control. It is important for patients to maintain regular consultations with their healthcare providers to discuss the implications of the test results and to manage their HIV-1 infection effectively.
| Short Descr | NFCT AGT GNTYP ALYS HIV1 REV | Medium Descr | NFCT AGT GNOTYP ALYS NUCLE ACD HIV1 REV TRNSCRPT | Long Descr | Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions | 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. | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2023-01-01 | Note | Short and medium descriptions changed. |
| 2013-01-01 | Changed | Code description revised. Medium descriptor changed. |
| 2011-01-01 | Changed | Long description revised. Medium description changed. Short description changed. |
| 2009-01-01 | Changed | Code description changed |
| 2002-01-01 | Changed | Code description changed. |
| 2001-01-01 | Added | First appearance in code book in 2001. |
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