The US Centers for Medicare & Medicaid Services has welcomed a Medicare reimbursement rate for CPT code 87900, a new code for 2006 that describes the vircoTYPE HIV-1 analysis. This service is used to help determine optimal antiretroviral drug therapy for patients with HIV.
Earlier this year, the American Medical Association’s (AMA) Current Procedural Terminology (CPT) editorial panel established Category I code 87900, described as infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics. The establishment of a code and a Medicare payment rate are significant moves towards making new medical technologies available to patients.
Recognizing the decision as the first of its kind, Werner Verbiest, head of Virco Worldwide said, This code has set a precedent and will help establish coding and payment for other bioinformatics technologies as we move into this new era of integrating diagnostic information with therapeutic decision-making.
He added, With a procedure code and established federal pricing, state and private health insurance providers are more likely to cover the vircoTYPE HIV-1 resistance analysis, providing even more access.
The news offers hope to the estimated half million HIV-positive patients taking antiretroviral therapy in the US. When the virus develops resistance, it is necessary to switch to another combination of drugs to once again suppress viral replication and, ultimately, to prevent HIV from progressing.
The technology provides quantitative resistance information that complements the widely used expert rules-based qualitative resistance information, and also demonstrates how resistant a virus is along a continuum that includes lower and upper clinical cutoffs. Furthermore, vircoTYPE HIV-1 is easily accessible by any laboratory worldwide via a customized Web-enabled software application (VircoNET). Dr Lee Bacheler, of Virco Lab, explained, Ultimately, this enables doctors anywhere in the world to discover treatment options that might otherwise have been unidentified by conventional resistance tests.