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Newsletter Vol. 14, No. 05
Act
immediately
Effective date
Nov 1, 2003
Identified
Jun 20, 2026
Summary
New Jersey Medicaid will reimburse for antiretroviral resistance testing (genotype, phenotype, virtual phenotype) with specific HCPCS codes and maximum fee allowances, limited to 3 tests per 12-month period. A completed criteria checklist must be kept with beneficiary medical records.
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What to do
immediately · 4 steps
01Laboratory billing teams must update systems to use new HCPCS codes 87901 ($350), 87999 ($80), 87903 ($675.72), and 87904 ($36) for antiretroviral resistance testing.
02Implement 3-test per 12-month period limit tracking.
03Providers must complete and maintain antiretroviral testing checklist criteria with beneficiary medical records.
04Contact Phyllis Valeri-Bruschini at 609-588-4610 for exceptions to testing limitations.
Codes mentioned
87901879998790387904
Original notice
Newsletter Vol. 14, No. 05
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 13, No. 71MediumEffective Nov 1, 2003 · Provider NoticeNewsletter Vol. 14, No. 01MediumEffective Jan 1, 2004 · Prior AuthorizationNewsletter Vol. 14, No. 02HighEffective Jan 21, 2004 · Provider NoticeNewsletter Vol. 14, No. 03LowEffective Dec 11, 2003 · PharmacyBrowse every New Jersey Medicaid change in the policy list