CPT 87902 Hepatitis C Genotype Reimbursement | OpenPayer

Summary & Overview

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

CPT code 87902 represents the technical laboratory component of a molecular diagnostic assay to determine the specific genotype of hepatitis C virus (HCV) from a patient specimen. Nationally, genotype determination guides clinical management of HCV, influences antiviral selection, and supports public health surveillance, making accurate billing and coding for this test important for clinical workflows and laboratory reimbursement.

This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for HCV genotyping, typical sites where the service is performed, commonly applied billing modifiers, and what to expect in payer coverage approaches. The publication summarizes available benchmarks and policy considerations, highlights coding definitions and service characterization, and notes where input data are unavailable.

Intended for laboratory managers, medical coders, and health policy analysts, the content clarifies the role of CPT code 87902 in laboratory billing for HCV genotype testing and outlines the practical implications for billing workflows and payer interactions at a national level.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicare87902CPTHepatitis CGenotype testingMolecular diagnosticsLaboratoryLab billingVirology testing

Billing Code Overview

CPT code 87902 describes a laboratory procedure in which a lab analyst performs the technical component of a nucleic acid test to determine the specific genotype of a specimen containing hepatitis C virus. This service is a molecular diagnostic assay focused on identifying viral genotype by analyzing nucleic acid from a patient specimen.

Service type: Laboratory molecular diagnostic testing (technical component)
Typical site of service: Clinical laboratory or hospital laboratory performing molecular virology testing

Data not available in the input for payers beyond those listed elsewhere, associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient with known chronic hepatitis C infection presents for genotype testing to guide antiviral therapy selection. The clinician collects a peripheral blood specimen (serum or plasma) which is sent to the molecular diagnostics laboratory. The laboratory analyst performs nucleic acid-based testing to determine the hepatitis C virus (HCV) genotype and subgenotype using validated molecular methods (for example, RT-PCR with sequencing or genotype-specific probes). Results are reported to the ordering provider and entered into the electronic medical record to inform direct-acting antiviral regimen choice and duration. Typical site of service is an independent clinical laboratory, hospital outpatient laboratory, or reference laboratory performing specialized molecular diagnostics.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional (interpretation) component separate from the technical component.
`TC`	Technical component	Use when billing only the technical component (laboratory testing, equipment, reagents).

CPT 87905: Enzymatic Activity Testing for Nonviral Infectious Agents

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

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

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

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

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

CPT 87912: Hepatitis B Virus Genotype Analysis, Nucleic Acid

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

CPT 87910: CMV Genotype Analysis by Nucleic Acid

CPT-87900-VIRAL-DRUG-SUSCEPTIBILITY-GENOTYPIC-PHENOTYPE-PREDICTION

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

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

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

CPT-87901-HIV-1-GENOTYPE-REVERSE-TRANSCRIPTASE-PROTEASE-ANALYSIS

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

CPT-87999-UNLISTED-MICROBIOLOGY-PROCEDURE

CPT 87999: Unlisted Microbiology Procedure

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

CPT 87903: HIV-1 Drug Resistance Nucleic Acid Analysis

Taxonomy Code	Specialty	Notes
207P00000X	Pathology & Laboratory Medicine	Clinical laboratory directors and molecular pathology specialists who oversee HCV genotyping.
207LP2900X	Clinical Laboratory Technologist	Laboratory technologists who perform nucleic acid testing and run assays.
207Q00000X	Public Health Laboratory	Reference and public health laboratories that perform confirmatory genotype testing.
2080P0001X	Infectious Disease	Ordering specialists who manage HCV and interpret genotype results for therapy selection.
208D00000X	Gastroenterology	Clinicians who treat hepatitis C and order genotype testing to guide antiviral therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B18.2`	Chronic viral hepatitis C	Primary indication for HCV genotype testing to guide antiviral selection and treatment duration.
`B17.10`	Acute hepatitis C without hepatic coma	Acute HCV infection may prompt genotype testing when clinical management decisions require genotype information.
`Z22.52`	Carrier of hepatitis C virus	Documentation of HCV carrier status may prompt periodic monitoring including genotype if treatment is considered.
`K74.60`	Unspecified cirrhosis of liver	Advanced liver disease due to chronic HCV where genotype guides therapy and prognostication.
`R74.8`	Abnormal levels of other serum enzymes	Abnormal liver tests often trigger HCV testing cascade including RNA and genotype assays.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87520`	Infectious agent detection by nucleic acid (e.g., hepatitis C), amplified probe technique, direct probe technique, or non-amplified probe technique; qualitative, single step method	Used for HCV RNA qualitative detection that may precede or accompany genotype testing to confirm active viremia.
`87522`	Infectious agent detection by nucleic acid (e.g., hepatitis C), amplified probe technique; quantification	Used for HCV RNA viral load testing to quantify viremia, essential for baseline assessment and treatment monitoring alongside genotype.
`0042U`	Hepatitis C virus genotype by next-generation sequencing, report of genotype and resistance-associated substitutions (laboratory test)	Performed in advanced molecular workflows to detect genotype and resistance mutations; may complement or replace traditional genotyping.
`87810`	Infectious agent antigen detection by immunoassay technique; hepatitis C antibody, screening	Initial screening test for prior HCV exposure; a positive result typically leads to nucleic acid testing and genotyping.
`G0472`	Hepatitis C screening, laboratory test for RNA, single step method	Alternative or payer-specific code used in some screening workflows before genotype testing.

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