Medicaid Expansion of Coverage for Human Immunodeficiency Virus (HIV) Testing

Date Issued: 11/25/2015

Effective December 1, 2015, New York State 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 test, approved by the U.S. Food and Drug Administration, 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 may help prevent HIV transmission and improve patient care.

While cases of HIV-1 are more prevalent in the United States than cases of HIV-2, both infections pose a crucial health risk in New York State. The appropriate course of care differs for HIV-1 and HIV-2, underscoring the importance of the ability to differentiate between HIV-1 and HIV-2 through testing.

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