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CPT 87901: HIV-1 Genotype Analysis of Reverse Transcriptase and Protease

CPT code 87901 represents a laboratory technical service that performs HIV‑1 genotypic analysis of the reverse transcriptase and protease regions from patient serum. This molecular diagnostic identifies resistance‑associated mutations that guide antiretroviral therapy selection and monitoring. As HIV treatment increasingly relies on precision genotyping to optimize outcomes and avoid drug resistance, accurate billing and coverage for this test has national significance for patients, laboratories, and payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how insurers commonly handle coverage and reimbursement for specialty molecular tests, though specific policy language and payment rates vary by contract and plan.

Readers will find a concise overview of the clinical context for HIV‑1 genotyping, common billing and coding considerations linked to the technical laboratory service, and benchmarks and policy themes relevant to payers and providers. The report summarizes payer coverage patterns, typical sites of service, and operational considerations for laboratories submitting claims for CPT code 87901. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 87901 describes a laboratory technical service that analyzes a patient specimen, typically serum, to determine the viral genotype of HIV‑1 by assessing the reverse transcriptase and protease regions. This test identifies mutations in the virus that affect antiretroviral drug susceptibility and informs clinical management of HIV infection.

Service type: Laboratory diagnostic genotyping test
Typical site of service: Clinical laboratory or reference diagnostic laboratory setting

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CPT 87901: HIV-1 Genotype Analysis of Reverse Transcriptase and Protease

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Billing Code Overview

Service type: Laboratory diagnostic genotyping test
Typical site of service: Clinical laboratory or reference diagnostic laboratory setting

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult living with HIV-1 who requires genotypic resistance testing to guide antiretroviral therapy. The patient presents for routine HIV care or for evaluation after virologic failure (rising or detectable plasma HIV-1 RNA) or suboptimal response to therapy. A blood specimen (usually plasma/serum) is collected by phlebotomy in an outpatient infectious disease clinic, HIV specialty clinic, or hospital laboratory. The specimen is sent to a reference molecular diagnostics laboratory where a laboratory analyst performs the technical testing to sequence or probe the reverse transcriptase and protease regions of the HIV-1 genome to identify resistance-associated mutations. Results are reported to the ordering clinician and used to select or modify antiretroviral regimens. Typical sites of service include outpatient clinics, hospital outpatient departments, and independent clinical laboratories performing molecular virology testing.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician or qualified professional interpretation for the test separate from the technical component.
`TC`	Technical component	Use when billing only the laboratory technical component (equipment, reagents, analysis) of the test.
`90`	Reference (outside) laboratory	Use when the test is performed by a non-participating or outside reference laboratory and billed separately.
`91`	Repeat clinical diagnostic laboratory test	Use when a repeat test on the same day is medically necessary to obtain a valid result.
`59`	Distinct procedural service	Use when another separately identifiable service is performed on the same day and needs to be distinguished from this test.
`91`	Duplicate (same-day) testing	Use when repeat testing of the same analyte is performed for confirmation (note: some payors require billing guidance).
`22`	Increased procedural services	Use when work or complexity substantially exceeds typical requirements for molecular testing and documentation supports increased complexity.
`52`	Reduced services	Use when the test is partially reduced or not fully performed and documentation supports reduced service.
`53`	Discontinued procedure	Use when testing is started but discontinued due to specimen or technical issues.
`90`	Outside lab billing	Use for tests sent to an external lab where the performing lab is not billing the same payer.

Taxonomy Code	Specialty	Notes
207RH0000X	Infectious Disease	Physicians who order and interpret HIV genotypic testing.
207K00000X	Internal Medicine	Primary care physicians managing HIV patients and ordering resistance testing.
207L00000X	Pathology	Pathologists overseeing laboratory testing and result validation.
363A00000X	Clinical Laboratory	Clinical laboratory personnel and directors responsible for performing molecular diagnostics.
208000000X	Family Medicine	Family physicians who may order HIV resistance testing in outpatient settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B20`	Human immunodeficiency virus [HIV] disease	Primary diagnosis for patients with HIV-1 infection requiring genotypic resistance testing.
`Z21`	Asymptomatic human immunodeficiency virus [HIV] infection status	Used for patients known to be HIV-positive but asymptomatic; may still require baseline or surveillance genotyping.
`R77.71`	Nonspecific reaction to HIV viral load	Reflects documented abnormal viral load prompting resistance testing.
`Z11.4`	Encounter for screening for human immunodeficiency virus [HIV]	Screening encounters may lead to confirmatory and follow-up testing including resistance assays if infection confirmed.
`B97.35`	Human immunodeficiency virus 1 as the cause of diseases classified elsewhere	Used when HIV-1 is the identified causative agent in other conditions and when genotypic testing guides management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87420`	Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification (viral load)	Performed before or alongside genotypic testing to assess viral load and determine need for resistance testing.
`88290`	Microbial identification by sequencing; short read (e.g., next-generation sequencing)	May be used in laboratories employing sequencing technologies for HIV genotyping; complements `87901` technical analysis.
`86701`	Antibody; HIV-1 (includes HIV-1/HIV-2 differentiation)	Initial serologic testing for HIV infection; typically performed earlier in diagnostic workflow.
`87421`	Infectious agent detection by nucleic acid; HIV-1, quantification, amplified probe technique	Alternative viral load methodology used in monitoring that informs need for genotypic resistance testing.
`99000`	Handling and/or conveyance of specimen for transfer from physician to laboratory	Administrative/transport code sometimes billed when specimens are sent to external reference labs (use varies by payer).

CPT 87900: Viral Drug Susceptibility Testing, Genotype-to-Phenotype Prediction

CPT-87902-HEPATITIS-C-GENOTYPE-NUCLEIC-ACID-TESTING-TECHNICAL

CPT 87902: Hepatitis C Genotype by Nucleic Acid, Technical Component

CPT-87903-HIV-1-DRUG-RESISTANCE-NUCLEIC-ACID-ANALYSIS

CPT 87903: HIV-1 Drug Resistance Nucleic Acid Analysis

CPT-87904-HIV-1-DRUG-RESISTANCE-ADDITIONAL-DRUG-TESTING

CPT 87904: HIV-1 Drug Resistance Analysis, Additional Drug

CPT-87905-ENZYMATIC-ACTIVITY-TESTING-INFECTIOUS-AGENT-TECHNICAL

CPT 87905: Enzymatic Activity Testing for Nonviral Infectious Agents

CPT-87906-HIV-1-GENOTYPE-NUCLEIC-ACID-NON-RT-PROTEASE-REGIONS

CPT 87906: HIV-1 Genotype by Nucleic Acid (Non-RT/Protease Regions)

CPT-87910-CMV-GENOTYPE-NUCLEIC-ACID-ANALYSIS

CPT 87910: CMV Genotype Analysis by Nucleic Acid

CPT-87912-HEPATITIS-B-GENOTYPE-ANALYSIS-NUCLEIC-ACID

CPT 87912: Hepatitis B Virus Genotype Analysis, Nucleic Acid

CPT-87913-SARS-COV-2-GENOTYPE-ANALYSIS-NEXT-GENERATION-SEQUENCING

CPT 87913: SARS–CoV–2 Genotype Analysis by Next-Generation Sequencing

CPT-87999-UNLISTED-MICROBIOLOGY-PROCEDURE

CPT 87999: Unlisted Microbiology Procedure

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician or qualified professional interpretation for the test separate from the technical component.
`TC`	Technical component	Use when billing only the laboratory technical component (equipment, reagents, analysis) of the test.
`90`	Reference (outside) laboratory	Use when the test is performed by a non-participating or outside reference laboratory and billed separately.
`91`	Repeat clinical diagnostic laboratory test	Use when a repeat test on the same day is medically necessary to obtain a valid result.
`59`	Distinct procedural service	Use when another separately identifiable service is performed on the same day and needs to be distinguished from this test.
`91`	Duplicate (same-day) testing	Use when repeat testing of the same analyte is performed for confirmation (note: some payors require billing guidance).
`22`	Increased procedural services	Use when work or complexity substantially exceeds typical requirements for molecular testing and documentation supports increased complexity.
`52`	Reduced services	Use when the test is partially reduced or not fully performed and documentation supports reduced service.
`53`	Discontinued procedure	Use when testing is started but discontinued due to specimen or technical issues.
`90`	Outside lab billing	Use for tests sent to an external lab where the performing lab is not billing the same payer.

Taxonomy Code	Specialty	Notes
207RH0000X	Infectious Disease	Physicians who order and interpret HIV genotypic testing.
207K00000X	Internal Medicine	Primary care physicians managing HIV patients and ordering resistance testing.
207L00000X	Pathology	Pathologists overseeing laboratory testing and result validation.
363A00000X	Clinical Laboratory	Clinical laboratory personnel and directors responsible for performing molecular diagnostics.
208000000X	Family Medicine	Family physicians who may order HIV resistance testing in outpatient settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B20`	Human immunodeficiency virus [HIV] disease	Primary diagnosis for patients with HIV-1 infection requiring genotypic resistance testing.
`Z21`	Asymptomatic human immunodeficiency virus [HIV] infection status	Used for patients known to be HIV-positive but asymptomatic; may still require baseline or surveillance genotyping.
`R77.71`	Nonspecific reaction to HIV viral load	Reflects documented abnormal viral load prompting resistance testing.
`Z11.4`	Encounter for screening for human immunodeficiency virus [HIV]	Screening encounters may lead to confirmatory and follow-up testing including resistance assays if infection confirmed.
`B97.35`	Human immunodeficiency virus 1 as the cause of diseases classified elsewhere	Used when HIV-1 is the identified causative agent in other conditions and when genotypic testing guides management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87420`	Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification (viral load)	Performed before or alongside genotypic testing to assess viral load and determine need for resistance testing.
`88290`	Microbial identification by sequencing; short read (e.g., next-generation sequencing)	May be used in laboratories employing sequencing technologies for HIV genotyping; complements `87901` technical analysis.
`86701`	Antibody; HIV-1 (includes HIV-1/HIV-2 differentiation)	Initial serologic testing for HIV infection; typically performed earlier in diagnostic workflow.
`87421`	Infectious agent detection by nucleic acid; HIV-1, quantification, amplified probe technique	Alternative viral load methodology used in monitoring that informs need for genotypic resistance testing.
`99000`	Handling and/or conveyance of specimen for transfer from physician to laboratory	Administrative/transport code sometimes billed when specimens are sent to external reference labs (use varies by payer).

CPT 87900: Viral Drug Susceptibility Testing, Genotype-to-Phenotype Prediction

CPT-87902-HEPATITIS-C-GENOTYPE-NUCLEIC-ACID-TESTING-TECHNICAL

CPT 87902: Hepatitis C Genotype by Nucleic Acid, Technical Component

CPT-87903-HIV-1-DRUG-RESISTANCE-NUCLEIC-ACID-ANALYSIS

CPT 87903: HIV-1 Drug Resistance Nucleic Acid Analysis

CPT-87904-HIV-1-DRUG-RESISTANCE-ADDITIONAL-DRUG-TESTING

CPT 87904: HIV-1 Drug Resistance Analysis, Additional Drug

CPT-87905-ENZYMATIC-ACTIVITY-TESTING-INFECTIOUS-AGENT-TECHNICAL

CPT 87905: Enzymatic Activity Testing for Nonviral Infectious Agents

CPT-87906-HIV-1-GENOTYPE-NUCLEIC-ACID-NON-RT-PROTEASE-REGIONS

CPT 87906: HIV-1 Genotype by Nucleic Acid (Non-RT/Protease Regions)

CPT-87910-CMV-GENOTYPE-NUCLEIC-ACID-ANALYSIS

CPT 87910: CMV Genotype Analysis by Nucleic Acid

CPT-87912-HEPATITIS-B-GENOTYPE-ANALYSIS-NUCLEIC-ACID

CPT 87912: Hepatitis B Virus Genotype Analysis, Nucleic Acid

CPT-87913-SARS-COV-2-GENOTYPE-ANALYSIS-NEXT-GENERATION-SEQUENCING

CPT 87913: SARS–CoV–2 Genotype Analysis by Next-Generation Sequencing

CPT-87999-UNLISTED-MICROBIOLOGY-PROCEDURE

CPT 87999: Unlisted Microbiology Procedure

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 87901: HIV-1 Genotype Analysis of Reverse Transcriptase and Protease

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Billing Code Overview

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CPT 87901: HIV-1 Genotype Analysis of Reverse Transcriptase and Protease

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 87901: HIV-1 Genotype Analysis of Reverse Transcriptase and Protease

Sign up for cpt 87901 policy alerts

Billing Code Overview

CPT 87901: HIV-1 Genotype Analysis of Reverse Transcriptase and Protease

Sign up for cpt 87901 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 87901 represent and what is its clinical purpose?

Where is the 87901 service typically performed and how is the specimen handled?

Which CPT modifiers are commonly used with 87901 and when are they applied?

What other CPT codes are related to HIV‑1 genotypic testing and how do they relate to 87901?

Which payers are referenced for coverage of CPT 87901 and does the page provide specific payment rates?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 87901 represent and what is its clinical purpose?

Where is the 87901 service typically performed and how is the specimen handled?

Which CPT modifiers are commonly used with 87901 and when are they applied?

What other CPT codes are related to HIV‑1 genotypic testing and how do they relate to 87901?

Which payers are referenced for coverage of CPT 87901 and does the page provide specific payment rates?

References