Medicaid Reimbursement for a Fourth Generation Combination Immunoassay for HIV

Effective for dates of service on or after December 1, 2013, laboratory providers may claim reimbursement for a fourth generation HIV diagnostic assay that simultaneously detects both antigen and antibodies for the human immunodeficiency virus (HIV). Laboratories should use CPT procedure code 87389 (infectious agent detection by enzyme immunoassay technique, qualitative or semiqualitative, multiple-step method: HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result) to bill for this test. The maximum reimbursement amount for procedure code 87389 is $18.49.