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The CPT® Code 87536 refers to the detection of the infectious agent HIV-1 through nucleic acid techniques, specifically focusing on quantification. This procedure involves the measurement of HIV-1 viral load in a patient's sample, which is crucial for monitoring the progression of the infection and the effectiveness of treatment. The process includes reverse transcription, which is a method used to convert RNA into DNA, allowing for the amplification and subsequent quantification of the viral genetic material. HIV-1 is a type of human immunodeficiency virus that primarily targets the immune system, leading to a gradual decline in the number of CD4 T-cells, which are essential for immune function. The presence of HIV-1 can lead to acquired immunodeficiency syndrome (AIDS) if not managed properly. The testing for HIV-1 is vital for individuals who may have been exposed to the virus through various means, including sexual contact, sharing of needles, or from mother to child during childbirth or breastfeeding. The procedure is performed on a blood sample, where the nucleic acids are extracted and analyzed to determine the viral load, providing essential information for treatment decisions and patient management.
© Copyright 2025 Coding Ahead. All rights reserved.
The CPT® Code 87536 is indicated for the following conditions and situations:
The procedure for CPT® Code 87536 involves several detailed steps to ensure accurate detection and quantification of HIV-1:
After the procedure associated with CPT® Code 87536, the patient may not require any specific post-procedure care, as the test is minimally invasive. However, it is important for healthcare providers to communicate the results to the patient promptly. The quantification results will guide further treatment decisions and management of the patient's HIV-1 infection. Patients may be advised to follow up with their healthcare provider to discuss the implications of the test results and any necessary adjustments to their treatment plan. Regular monitoring of viral load is recommended to ensure effective management of the infection.
| Short Descr | HIV-1 QUANT&REVRSE TRNSCRPJ | Medium Descr | IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION | Long Descr | Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 206 - Microscopic examination (bacterial smear, culture, toxicology) |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | GA | Waiver of liability statement issued as required by payer policy, individual case | GZ | Item or service expected to be denied as not reasonable and necessary | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | Q4 | Service for ordering/referring physician qualifies as a service exemption | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2014-01-01 | Changed | Description Changed |
| 2013-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Short description changed. |
| 1998-01-01 | Added | First appearance in code book in 1998. |