MedicaidBilling CodesMedium impact
Newsletter Vol. 14, No. 05
New Jersey Medicaid·NJ · Infectious Disease·Coding
Effective date
Nov 1, 2003
We identified it
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.
Action Required
Immediately: Laboratory billing teams must update systems to use new HCPCS codes 87901 ($350), 87999 ($80), 87903 ($675.72), and 87904 ($36) for antiretroviral resistance testing. Implement 3-test per 12-month period limit tracking. Providers must complete and maintain antiretroviral testing checklist criteria with beneficiary medical records. Contact Phyllis Valeri-Bruschini at 609-588-4610 for exceptions to testing limitations.