Retroactive to dates of service on or after September 4, 2007, the Trofile test is a Medi-Cal benefit and can be billed using CPT-4 code 87999 (unlisted microbiology procedure). Current Medi-Cal reimbursement for this code is "By Report."
This blood test is available for recipients with diagnosed Acquired Immune Deficiency Syndrome (AIDS) who have evidence of viral replication and HIV-1 strain resistance to multiple anti-retroviral agents. This test will help determine if the recipient will respond to a new class of drugs, classified as CCR-5 antagonists.
This test is to be performed only once in the recipientÃ•s lifetime. Providers must document on the claim that the recipient has evidence of anti-retroviral drug resistance intolerance and a lack of patient acceptability to reasonable alternative anti-retroviral drug regimens resulting in inability to fully suppress HIV. Failure to provide such documentation will result in denial of the claim.