Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)

Baseline plasma HIV RNA testing is covered for any patient with confirmed HIV infection and may be performed in at-risk individuals when initiation of therapy is anticipated (including borderline serology or acute retroviral symptoms). Serial, periodic viral load measurements are covered for prognostic assessment and monitoring antiretroviral therapy, with testing frequency and practices (including use of the same assay and baseline specimen collection of two samples within two weeks) aligned with current CDC guidelines and documented in the medical record.

"A baseline plasma HIV RNA (viral load) measurement is medically necessary for any patient with confirmed HIV infection."

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