O98.72 — Human immunodeficiency virus [HIV] disease complicating childbirth
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- HIV tropism testing with a phenotypic co-receptor tropism assay is consideredmedically necessaryin an HIV-1 infected individual foreitherof the following indications:
- Prior to initiating a combination antiretroviral drug regimen with a co-receptor antagonist (CCR5 inhibitor, that is, maraviroc);or
- In an individual who has experienced virologic failure while receiving therapy that contains a CCR5 inhibitor.
1 Active Policy
ANTHEM-CG-LAB-03 — CG-LAB-03 Tropism Testing for HIV Management
Related Codes
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