Modifications were recently made to the Medicaid billing policy for HIV drug resistance testing in response to Office of State Comptroller (OSC) recommendations to prevent overutilization for such testing.
New York Medicaid currently covers up to three HIV genotypic (87901) and HIV phenotypic (87903) drug resistance tests in any combination for beneficiaries within a 365 day period.
For dates of service on or after January 1, 2010, Medicaid will reimburse laboratories for up to four HIV genotypic and phenotypic drug resistance tests in any combination within a 365 day period.
Note: The virtual phenotype drug resistance test (87900) is unaffected by this change and may continue to be billed a maximum of three times per recipient within a 365 day period, regardless of the number of HIV genotypic or HIV phenotypic drug resistance tests that have previously been provided the patient.
