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Infectious agent phenotype analysis by nucleic acid (DNA or RNA) for HIV-1 is a specialized laboratory procedure that assesses the virus's characteristics and its resistance to various antiretroviral medications. This analysis is crucial for managing HIV infections, as it helps healthcare providers determine the most effective treatment options for patients. The human immunodeficiency virus (HIV) specifically targets the immune system, particularly the T cells or CD4 cells, which are essential for the body's ability to combat infections. When these cells are destroyed, the immune system becomes compromised, leading to increased susceptibility to opportunistic infections and diseases. HIV is the causative agent of acquired immunodeficiency syndrome (AIDS), which represents the advanced stage of HIV infection. The phenotyping process typically involves obtaining a blood sample, although tissue samples may also be utilized. The collected sample is cultured in a laboratory setting, where it undergoes testing to evaluate its resistance to multiple antiretroviral drugs at varying concentrations. This complex testing procedure demands significant labor and expertise from skilled clinicians to ensure accurate interpretation of the results. For coding purposes, the CPT® code 87903 is designated for the analysis of the first ten drugs tested, while 87904 is used for each additional drug beyond the initial ten.
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The infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis for HIV-1 is indicated for the following:
The procedure for infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis for HIV-1 involves several critical steps:
After the completion of the infectious agent phenotype analysis, patients may require follow-up consultations to discuss the results. The healthcare provider will interpret the findings and recommend appropriate treatment options based on the identified drug resistance patterns. It is essential for patients to adhere to the prescribed treatment regimen to manage their HIV effectively. Additionally, ongoing monitoring may be necessary to assess the effectiveness of the treatment and to detect any changes in the virus's resistance profile over time.
| Short Descr | PHENOTYPE DNA HIV W/CULTURE | Medium Descr | NFCT PHEXYP RESIST TISS CUL HIV FIRST 1-10 DRUGS | Long Descr | Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through 10 drugs tested | 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) |
This is a primary code that can be used with these additional add-on codes.
| 87904 | Addon Code MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC Q4 PUB 100 CPT Assistant Article Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each additional drug tested (List separately in addition to code for primary procedure) |
| 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. | 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. |
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| 2011-01-01 | Changed | Short description changed. |
| 2002-01-01 | Changed | Code description changed. |
| 2001-01-01 | Added | First appearance in code book in 2001. |
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