Billing Beat

Expansion of Medicaid Managed Care Covered Benefits to Include HIV Resistance Testing Effective April 1, 2014 – Updated

May 28, 2014

The March 2014 Medicaid Update article explained that effective April 1, 2014, as a part of MRT proposal #1458, Medicaid Managed Care Plans (MMCP) began coverage of the following HIV resistance laboratory tests as prescribed by a physician: Genotypic testing; Phenotypic testing; and  HIV tropism assay. These laboratory tests may be used in any combination to identify specific HIV strains and drug resistance in order to determine the most effective treatment. The original Medicaid Update Article inadvertently omitted CPT code 87906; this code should be recognized as a covered laboratory test.

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