MedicaidCoverageMedium impact
Newsletter Vol. 13, No. 71
New Jersey Medicaid·NJ · Infectious Disease·Provider Notice
Effective date
Nov 1, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and NJ FamilyCare will now reimburse for antiretroviral resistance testing (genotype, phenotype, and virtual phenotype) for HIV patients, with specific fee schedules and a limit of three tests per 12-month period. Providers must complete and maintain a specific criteria checklist in patient medical records.
Action Required
Immediately: Laboratory billing teams must update systems to bill new HCPCS codes 87901 ($350), 87999 ($80), 87903 ($675.72), and 87904 ($36) for antiretroviral resistance testing. Providers must complete the Antiretroviral Testing Checklist and maintain it in patient medical records. Contact Phyllis Valeri-Bruschini at 609-588-4610 for exceptions to the 3-test annual limit. Retain newsletter behind blue tab marked '5'.