**Indications**

Diagnostic testing to establish HIV infection may be indicated when there is a
strong clinical suspicion supported by one or more of the following clinical
findings:

  1. The patient has a documented, otherwise unexplained, AIDS-defining or AIDS-associated opportunistic infection.
  2. The patient has another documented sexually transmitted disease which identifies significant risk of exposure to HIV and the potential for an early or subclinical infection.
  3. The patient has documented acute or chronic hepatitis B or C infection that identifies a significant risk of exposure to HIV and the potential for an early or subclinical infection.
  4. The patient has a documented AIDS-defining or AIDS-associated neoplasm.
  5. The patient has a documented AIDS-associated neurologic disorder or otherwise unexplained dementia.
  6. The patient has another documented AIDS-defining clinical condition, or a history of other severe, recurrent, or persistent conditions which suggest an underlying immune deficiency (for example, cutaneous or mucosal disorders).
  7. The patient has otherwise unexplained generalized signs and symptoms suggestive of a chronic process with an underlying immune deficiency (for example, fever, weight loss, malaise, fatigue, chronic diarrhea, failure to thrive, chronic cough, hemoptysis, shortness of breath, or lymphadenopathy).
  8. The patient has otherwise unexplained laboratory evidence of a chronic disease process with an underlying immune deficiency (for example, anemia, leukopenia, pancytopenia, lymphopenia, or low CD4+ lymphocyte count).
  9. The patient has signs and symptoms of acute retroviral syndrome with fever, malaise, lymphadenopathy, and skin rash.
  10. The patient has documented exposure to blood or body fluids known to be capable of transmitting HIV (for example, needle sticks and other significant blood exposures) and antiviral therapy is initiated or anticipated to be initiated.
  11. The patient is undergoing treatment for rape. (HIV testing is a part of the rape treatment protocol.)

**Limitations**

  1. HIV antibody testing in the United States is usually performed using HIV-1 or HIV-12 combination tests. HIV-2 testing is indicated if clinical circumstances suggest HIV-2 is likely (that is, compatible clinical findings and HIV-1 test negative). HIV-2 testing may also be indicated in areas of the country where there is greater prevalence of HIV-2 infections.
  2. The Western Blot test should be performed only after documentation that the initial EIA tests are repeatedly positive or equivocal on a single sample.
  3. The HIV antigen tests currently have no defined diagnostic usage.
  4. Direct viral RNA detection may be performed in those situations where serologic testing does not establish a diagnosis but strong clinical suspicion persists (for example, acute retroviral syndrome, nonspecific serologic evidence of HIV, or perinatal HIV infection).
  5. If initial serologic tests confirm an HIV infection, repeat testing is not indicated.
  6. If initial serologic tests are HIV EIA negative and there is no indication for confirmation of infection by viral RNA detection, the interval prior to retesting is 3-6 months.
  7. Testing for evidence of HIV infection using serologic methods may be medically appropriate in situations where there is a risk of exposure to HIV.
  8. The CPT Editorial Panel has issued a number of codes for infectious agent detection by direct antigen or nucleic acid probe techniques that have not yet been developed or are only being used on an investigational basis. Laboratory providers are advised to remain current on FDA-approval status for these tests.

Note: Scroll down for links to the quarterly Covered Code Lists (including
narrative).