CG-LAB-03 Tropism Testing for HIV Management

This policy addresses HIV-1 co-receptor tropism testing using a phenotypic assay. It is medically necessary only for HIV-1–infected individuals either before starting a CCR5 antagonist (e.g., maraviroc) or after virologic failure while on a CCR5 inhibitor regimen; all other indications are not covered. Non-covered uses include genotypic tropism assays, repeat testing during CCR5 antagonist treatment or after failure, and use to predict disease progression.

"HIV tropism testing with a phenotypic co-receptor tropism assay is consideredmedically necessaryin an HIV-1 infected individual foreitherof the following indications:"

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