Summary & Overview
CPT 87390: HIV-1 Antigen Immunoassay
CPT code 87390 denotes an immunoassay performed to detect HIV-1 antigens, a laboratory diagnostic used to identify acute or ongoing human immunodeficiency virus type 1 infection. This antigen assay is clinically important for early detection, public health surveillance, and informing treatment initiation. Nationally, antigen testing complements antibody assays and nucleic acid testing in diagnostic algorithms and screening programs.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose and testing context for CPT code 87390, a summary of common billing modifiers and administrative considerations, and a presentation of available benchmarking and coverage elements where provided. The publication outlines typical sites of service and service type, and highlights intersections with diagnostic workflows and laboratory reporting.
Data not available in the input is noted where specific payer policies, reimbursement benchmarks, ICD-10 mappings, and provider taxonomies would otherwise be presented.
Billing Code Overview
CPT code 87390 describes a laboratory immunoassay performed by a lab analyst to detect antigens of human immunodeficiency virus 1 (HIV-1 antigen), commonly using techniques such as enzyme immunoassay (EIA). The test identifies the presence of viral antigen markers that indicate acute or ongoing HIV-1 infection.
Service Type: Laboratory diagnostic test (viral antigen immunoassay)
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 28-year-old sexually active patient presents to an outpatient clinic for routine sexually transmitted infection screening after reporting a recent new sexual partner. The clinician documents risk factors including inconsistent condom use and requests HIV screening. A venous blood specimen is collected and sent to the laboratory where a medical laboratory scientist performs an antigen/antibody immunoassay for human immunodeficiency virus type 1 (HIV-1) using an enzyme immunoassay (EIA) technique represented by 87390. The typical workflow includes patient registration and consent, phlebotomy, specimen labeling and transport to the clinical laboratory, accessioning, performance of the EIA by lab personnel, verification of controls, result interpretation, and reporting of negative or reactive results to the ordering clinician. Reactive (preliminary positive) immunoassay results prompt supplemental testing per facility protocol (e.g., HIV-1/HIV-2 differentiation or nucleic acid testing) and public health reporting as required. Typical site of service for 87390 is outpatient clinic or hospital laboratory performing routine diagnostic serology; the service type is a laboratory immunoassay for detection of HIV-1 antigen/antibody.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |