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New Jersey MedicaidMedicaid · Coverage · Provider Notice · NJ · Infectious DiseaseMedium impact

Newsletter Vol. 13, No. 71

Act
immediately
Effective date
Nov 1, 2003
Identified
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.

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What to do

immediately · 4 steps
01Laboratory billing teams must update systems to bill new HCPCS codes 87901 ($350), 87999 ($80), 87903 ($675.72), and 87904 ($36) for antiretroviral resistance testing.
02Providers must complete the Antiretroviral Testing Checklist and maintain it in patient medical records.
03Contact Phyllis Valeri-Bruschini at 609-588-4610 for exceptions to the 3-test annual limit.
04Retain newsletter behind blue tab marked '5'.

Codes mentioned

87901879998790387904

Original notice

Newsletter Vol. 13, No. 71
njmmis.com · Always check the source before changing claims.
View original ↗

Related changes

See all New Jersey Medicaid changes →
Newsletter Vol. 14, No. 05MediumEffective Nov 1, 2003 · CodingNewsletter Vol. 10, No. 23HighEffective Jan 1, 2000 · CodingNewsletter Vol. 13, No. 01LowEffective Jan 1, 2003 · Provider NoticeNewsletter Vol. 13, No. 02MediumEffective Jan 1, 2003 · CodingBrowse every New Jersey Medicaid change in the policy list

Related policy hubs

New Jersey Medicaid policiesNJ policy changesInfectious DiseaseCode 87901Code 87999Code 87903Code 87904

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