Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.mass.gov/dma	
	MassHealth
	Physician Bulletin 76
	January 2002

	TO:	Physicians Participating in MassHealth

	FROM:	Wendy E. Warring, Commissioner

	RE:	HIV Resistance Testing

New Lab Services	Effective January 1, 2002, the Division is providing coverage for HIV 
for Members with HIV 	genotype and phenotype resistance tests.  These services are payable with prior authorization (PA) from the Division and only when provided by independent clinical laboratories with certain certifications from the Centers for Medicare and Medicaid Services under the Clinical Laboratory Improvement Act (CLIA). 

	Physicians who want to order these specialized tests to help them manage their HIV patients’ treatment must request PA from the Division.  If the Division authorizes the service, the physician must provide the laboratory with a copy of the letter from the Division approving the test along with the order for testing.

Service Codes	To request PA for these tests, you must fill out and submit a Request for Prior Authorization.  The codes for these lab tests are listed below.

87901	Infectious agent genotype analysis by nucleic acid (DNA or RNA), HIV 1, reverse transcriptase and protease (P.A. required for third and subsequent tests performed within a calendar year)
87903	Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; up to 10 drugs (P.A.)
87904	each additional drug, up to 5 drugs (List separately in addition to code for primary procedure.) (P.A.)

Supplemental PA Form	In order to request PA for any of the above three laboratory tests, you must completely fill out and sign the HIV Resistance Testing Request Form, and attach it to the Request for Prior Authorization.  

	

Ordering Supplies	To get supplies of the HIV Resistance Testing Request Form or the Request for Prior Authorization, mail or fax your request to:
MassHealth 
Forms Distribution
P.O. Box 9101
Somerville, MA  02145
Fax:  703-917-4937

Include your MassHealth provider number and street address with your request.  

Questions	If you have any questions about the information in this bulletin, please contact MassHealth Provider Services at 617-628-4141 or 1‑800‑325‑5231.