Need help choosing the right code?
Ask CasePilot about procedures, modifiers, bundling, and coding guidance.
Try CasePilot© Copyright 2026 American Medical Association. All rights reserved.
Infectious agent phenotype analysis by nucleic acid (DNA or RNA) for HIV-1 involves a specialized laboratory procedure that assesses the virus's characteristics and its resistance to various antiretroviral medications. This analysis is crucial for understanding how the human immunodeficiency virus (HIV) interacts with the immune system, particularly how it targets and destroys T cells, also known as CD4 cells, which are essential for a robust immune response. The presence of HIV can lead to acquired immunodeficiency syndrome (AIDS), a severe condition that significantly compromises the body's ability to combat infections. The phenotyping process typically utilizes blood samples, although tissue samples may also be employed. During the procedure, the collected blood or tissue is cultured, allowing for the growth of the virus, which is then subjected to testing against multiple antiretroviral drugs at varying concentrations. This complex testing requires significant labor and expertise from skilled clinicians to ensure accurate interpretation of the results. For billing purposes, CPT® Code 87904 is used to report each additional drug tested beyond the first ten, which are reported under CPT® Code 87903.
© Copyright 2026 Coding Ahead. All rights reserved.
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 and any necessary changes to their treatment regimen. The healthcare provider will review the findings with the patient, explaining the implications of the drug resistance patterns identified. Additionally, ongoing monitoring and support may be necessary to ensure the effectiveness of the adjusted treatment plan and to manage any potential side effects or complications associated with the therapy.
| Short Descr | PHENOTYPE DNA HIV W/CLT ADD | Medium Descr | NFCT PHEXYP RESIST TISS CUL HIV EA ADDL DRUG | Long Descr | 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) | 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 | 17 | CCS Clinical Classification | 206 - Microscopic examination (bacterial smear, culture, toxicology) |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 87903 | 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; first through 10 drugs tested |
| 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. | 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. |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2011-01-01 | Changed | Short description changed. |
| 2006-01-01 | Changed | Code description changed. |
| 2002-01-01 | Changed | Code description changed. |
| 2001-01-01 | Added | First appearance in code book in 2001. |
Get instant expert-level medical coding assistance.