Summary & Overview
CPT 87904: HIV-1 Drug Resistance Analysis, Additional Drug
CPT code 87904 covers the technical laboratory work for nucleic acid analysis of tissue from an HIV-1–positive patient to identify drug resistance, specifically billed for each additional drug tested after the first ten. Nationally, this code matters because it captures incremental laboratory activity tied to extensive resistance panels used in managing complex HIV care and antiretroviral therapy adjustments. Payers commonly involved in coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what the code represents clinically and administratively, which payers are typically relevant to coverage and claims adjudication, and how the code fits into laboratory service lines for infectious disease management. The summary provides context for benchmarking laboratory utilization, clarifies the service type and usual site of service, and identifies where to look for policy language and fee schedule treatment. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 87904 describes a technical laboratory procedure in which a lab analyst performs nucleic acid analysis on a tissue sample from an HIV-1–positive patient to determine drug resistance through culture analysis. This code is used for each additional drug tested after the first ten drugs in the resistance panel.
Service type: Laboratory — technical component for HIV-1 drug resistance testing
Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with known HIV-1 infection and a rising plasma viral load despite antiretroviral therapy presents to the infectious disease clinic. The ordering clinician obtains a plasma sample and sends it to a reference virology laboratory for genotypic resistance testing. The lab performs nucleic acid extraction and culture-based analysis to detect resistance-associated mutations and to determine phenotypic resistance to multiple antiretroviral drugs. The initial panel includes up to 10 drugs; when the analyst performs testing on each additional drug beyond the first 10, billing is reported using 87904. Results are returned to the treating infectious disease specialist, who integrates resistance findings with clinical history to guide regimen selection. Typical sites of service include outpatient infectious disease clinics and independent or hospital-based molecular virology laboratories that process patient specimens for HIV drug resistance testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional (interpretation) portion of the test separate from the technical component. |
TC |