Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesPhenotype and Genotype-Infectious AgentsCPT cpt-87903-hiv-1-drug-resistance-nucleic-acid-analysis
    Ask Trek AI about this page

    CPT 87903: HIV-1 Drug Resistance Testing, Culture-Based

    CPT code 87903 describes a laboratory technical procedure in which a lab analyst analyzes nucleic acids from a tissue sample of an HIV-1 positive patient to determine antiretroviral drug resistance using culture-based testing for up to the first 10 drugs tested; service type: molecular/genotypic and phenotypic drug resistance testing, typical site of service: clinical laboratory or reference lab performing specialized HIV resistance assays.

    For related coverage guidance, see recent payer policy updates: Biomarker Testing for Autoimmune Rheumatic Disease, Immunopharmacologic Monitoring of Therapeutic Serum Antibodies, Immune Cell Function Assay.

    Customize your policy alerts

    Sign up for cpt 87903 policy alerts

    Get alerted when payer policies referencing 87903 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A 38-year-old patient with known HIV-1 infection presents to an infectious disease clinic with rising plasma viral load and suboptimal virologic response after a change in antiretroviral regimen. The clinician orders genotypic and phenotypic resistance testing from a laboratory that performs nucleic acid analysis and culture-based drug susceptibility testing. A specimen (plasma or tissue-derived viral isolate) is collected and sent to a reference virology lab. In the laboratory workflow, a lab analyst extracts nucleic acids from the sample, performs culture and phenotypic assays to assess HIV-1 susceptibility to antiretroviral agents, and reports resistance results for up to the first 10 drugs tested. Results are returned to the ordering clinician to guide selection of an effective antiretroviral regimen.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    87903The lab analyst performs the technical lab test to analyze the nucleic acids from a sample of tissue from an HIV 1 positive patient to determine drug resistance through culture analysis for up to the first 10 drugs tested.Primary technical service for culture-based HIV-1 drug resistance testing; billed for the lab performance of the assay.

    87904 | Laboratory analysis for HIV-1 drug resistance by phenotypic methods for additional drugs beyond the first 10 tested (hypothetical companion code). | May be used when more than 10 drugs are evaluated or for additional phenotypic panels following initial testing.

    87661 | Infectious agent detection by nucleic acid (e.g., HIV-1 RNA), amplified probe technique, quantitative. | Often performed prior to or concurrently with resistance testing to quantify viral load and confirm specimen suitability for phenotypic assays.

    87663 | HIV-1 quantification, viral load testing via nucleic acid; used in monitoring therapy response. | Viral load measurement informs interpretation of resistance testing and clinical decision-making.

    87389 | Antibody/antigen detection assays for HIV may be part of the diagnostic workflow before resistance testing. | Used earlier in the diagnostic pathway; less directly related but may appear in the patient's testing history.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RG0100X
    2080P0208X
    125K00000X
    291900000X
    163WA0400X
    332BP3500X
    176P00000X
    163WH0500X

    Related Payer Policy Updates

    Specialty: Immunology/Rheumatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Biomarker Testing for Autoimmune Rheumatic DiseaseOscar Health2026-10-01
    Immunopharmacologic Monitoring of Therapeutic Serum AntibodiesOscar Health2026-10-01
    Immune Cell Function AssayOscar Health2026-10-01
    Biomarker Testing for Autoimmune Rheumatic DiseaseBlue Cross Blue Shield - New Mexico2026-09-04
    Inflammatory Conditions - Orencia Intravenous Preferred Specialty Management Policy for Legacy Prescription Drug ListsCigna2026-09-01
    Secukinumab (Cosentyx) — intravenous (Medicare Advantage)blue cross blue shield - louisiana2026-09-01
    Intravenous Immune Globulin (IVIG) — indications and authorization criteriaBlue Cross Blue Shield - Iowa2026-08-28
    Infliximab Intravenous Products Preferred Specialty Management PolicyCigna2026-08-15
    Kineret (anakinra) — Coverage CriteriaBlue Cross Blue Shield - Iowa2026-08-14
    Actimmune (interferon gamma-1b) — Prior Authorization and Coverage Criteriameridian_health_plan_of_michigan2026-08-01

    Related Codes

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

    CPT 87900: Viral Drug Susceptibility and Phenotype Prediction

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

    CPT 87901: HIV‑1 Genotype — Protease and Reverse Transcriptase Sequencing

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

    CPT 87902: Hepatitis C Virus Genotype by Nucleic Acid Analysis

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

    CPT 87904: HIV‑1 Drug Resistance Test, Additional Drug

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

    CPT 87905: Enzymatic Activity Test for Non-Viral Infectious Agents

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

    CPT 87906: HIV‑1 Genotype by Nucleic Acid (non-RT/protease)

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

    CPT 87910: CMV Genotype Analysis by Nucleic Acid Testing

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

    CPT 87912: Hepatitis B Virus Genotype Analysis

    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. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    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.