CPT code 87903: HIV resistance, phenotype, first 10 drugs2026 Medicare lab fee · Clinical Laboratory Fee Schedule
HIV-1 phenotypic resistance testing combines nucleic acid analysis and tissue culture to assess susceptibility across the first 10 antiretroviral drugs tested.
Medicare pays $488.66 for 87903 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$488.66
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- CMS updates
- Quarterly
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 8 sections
What 87903 covers
Code 87903 identifies HIV-1 phenotypic drug-resistance testing that combines nucleic acid analysis with tissue-culture analysis. The base tier covers the first through 10 drugs tested. The assay characterizes HIV-1 response to antiretroviral drugs and can inform treatment selection when resistance testing is ordered. Laboratory reports should make clear that the service was phenotypic and identify the drugs included. This differs from HIV-1 genotypic resistance analysis, which reports genetic findings rather than this phenotype service.
Report one unit for the initial tier of up to 10 drugs; report 87904 for each additional group of 10 drugs tested. Medicare pays 87903 under the CLFS at one national amount in every locality, with no office-versus-facility difference. The 2026 national amount is $488.66, unchanged since 2020. The test is excluded from the physician fee schedule.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 87903
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 87903. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 87903 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87903 on the lab fee schedule since 2020
87903 · CLFS 2026 Q4 (current)
$488.66
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
87903 compared with similar tests
- 87901HIV genotypeRT and protease regions$257.45
- 87901 reports HIV-1 genotype analysis. Use 87903 when the service performed is the phenotypic resistance assay involving tissue-culture analysis.
- 87900Drug susceptibilityGenotype-based bioinformatics prediction$130.35
- 87900 describes infectious-agent phenotypic analysis. Code 87903 is specific to HIV-1 and covers the first through 10 drugs tested.
- 87904HIV-1 phenotypeEach additional drug$26.07
- 87903 covers the initial tier of the first through 10 drugs; 87904 is reported for each additional group of 10.
87903 billing questions
When should 87903 be reported instead of an HIV-1 genotype test?
Report 87903 when the assay performed is HIV-1 phenotypic resistance testing with nucleic acid and tissue-culture analysis. Genotype codes describe a different, gene-based resistance analysis.
How many units are reported for the first 10 drugs?
Report one unit for the initial tier covering the first through 10 drugs tested, not one unit per drug.
How are more than 10 drugs reported?
Report 87903 for the initial tier and 87904 for each additional group of 10 drugs tested.
Does Medicare pay 87903 under the physician fee schedule?
No. Medicare pays 87903 under the CLFS; the test is excluded from the physician fee schedule.
What should the laboratory report identify?
It should identify the HIV-1 phenotypic resistance service and the drugs tested, including any additional group reported with 87904.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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