87906 Insurance Policy Changes

HIV Drug Susceptibility and Resistance Tests (CPB 0316, reviewed 2026-05-21)

Aetna's updated HIV Drug Susceptibility and Resistance Tests policy (CPB 0316, effective 2026-05-21) clarifies coverage criteria for phenotypic and genotypic resistance testing. Key changes: simultaneous phenotypic AND genotypic testing is NOT covered (considered duplicative), but alternate testing may be approved on exception basis for virologic failure; tropism testing (Trofile/V3-loop) is covered only before CCR5 antagonist initiation; testing is NOT covered for patients with viral loads <1,000 copies/ml, those who discontinued antiretrovirals, or for unapproved indications. CPT code 0219U is explicitly NOT covered.