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Expansion of Coverage for Human Immunodeficiency Virus (HIV) Testing

Effective December 1, 2015, Medicaid Managed Care will begin reimbursement for an HIV-1/2 immunoassay capable of detecting HIV-1 antigen(s) and HIV-1 and HIV-2 antibodies (CPT 87806) in an office setting. 


The U.S. Food and Drug Administration approved test was added to the laboratory fee schedule earlier this year and is a new procedure code for 2015.  This rapid test, commonly referred to as an AG/ab combo or 4th generation immunoassay, detects the presence of HIV-1 p24 antigen as well as antibodies to both HIV-1 and HIV-2, allowing for an earlier diagnosis.  Early detection not only aids in patient care but also may help prevent HIV transmission.


Please see the September 2015 Medicaid Update article entitled “New York State Medicaid Expansion of Coverage for Human Immunodeficiency Virus (HIV) Testing” for more detailed information.


Additional information regarding rapid HIV testing can be found on the New York State Department of Health website.


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Last Updated On: 3/24/2016
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