Summary & Overview
CPT 87903: HIV-1 Drug Resistance Nucleic Acid Analysis
CPT code 87903 represents a laboratory technical molecular diagnostic assay used to analyze nucleic acids from a tissue sample of an HIV‑1 positive patient to determine antiviral drug resistance through culture analysis for up to the first ten drugs tested. This code captures the technical component of a specialized resistance test that informs clinical decisions about antiretroviral therapy and supports public health surveillance and personalized care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of the code’s clinical context, typical use cases, and the payer landscape. The publication outlines benchmarks and utilization patterns where available, highlights policy and coverage considerations affecting laboratory reimbursement, and provides practical context about where and how the test is performed.
This summary equips laboratory managers, billing professionals, and clinical leaders with a concise reference to the purpose and application of CPT code 87903, what to expect in terms of typical site-of-service delivery, and the types of payer policies that most frequently govern coverage. Data not provided in the input (for example, associated taxonomies, detailed payer rules, and ICD‑10 pairings) are noted as unavailable.
Billing Code Overview
CPT code 87903 describes a laboratory technical service in which a lab analyst performs nucleic acid analysis from a tissue sample obtained from an HIV‑1 positive patient to determine antiviral drug resistance by culture analysis for up to the first ten drugs tested. This service is a laboratory molecular diagnostic assay for HIV‑1 drug resistance.
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Service type: Technical laboratory molecular diagnostic analysis
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Typical site of service: Clinical laboratory or reference laboratory (specimens collected in outpatient clinics or hospitals and processed in a laboratory setting)
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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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional Component | Use when billing for the interpretive/professional portion of the test if separated from the technical component. |
59 | Distinct Procedural Service | Use when this service is distinct from other procedures performed on the same day and not normally reported together.
62 | Two Surgeons | Use when two qualified laboratory directors/physicians are required and share responsibility (rare for this test).