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Wisconsin AIDS/HIV Laboratory Reimbursement Program

The Wisconsin AIDS/HIV Laboratory Reimbursement Program covers the cost of CD4+ T cell counts, plasma HIV RNA levels, antiretroviral resistance testing, and two tests needed for the use of specific antiviral medications for uninsured, HIV-positive individuals who live in Wisconsin, regardless of where they receive services.

The program is funded by a portion of the federal Ryan White Part B (formerly Title II) Grant.  The program began July 2, 2007 and retroactively covers the cost of laboratory tests performed from April 1, 2007 through the end of the Ryan White fiscal year (March 31, 2008). 

Patient Eligibility 

To be eligible to receive benefits under the program, the HIV-positive individual must:  

  • live in Wisconsin and
  • lack insurance coverage.

Persons with public (Medicaid, Medicare, VA, GAMP, HIRSP) or private insurance of any kind are NOT eligible for the program. Note that individuals who are in the 6-month waiting period for HIRSP are eligible for this program.

Because HIV infection is a reportable condition, reimbursement is contingent on receipt of the patient's case report by AIDS/HIV Program.  If a reimbursement request is submitted for a patient who has not yet been reported, staff from the AIDS/HIV Program will contact the submitting physician to generate a case report via telephone.  Once a case report has been generated, the request will be processed.  

It is the responsibility of the claimant to verify that the patient meets the eligibility criteria and that this program is being used as the payer of last resort. 

Covered Laboratory Tests

Reimbursement requests may be submitted for the following laboratory tests:

  • CD4 T cell count/percentage
    • Up to 4 tests in a 12-month period per individual, consistent with current recommendations.
  • Plasma HIV RNA level (i.e. Viral Load)
    •  Up to 4 tests in a 12-month period per individual, consistent with current recommendations.
  • Antiretroviral resistance
    • Up to 2 tests in a 12-month period per individual, consistent with the accepted time frames defining virologic failure.
  • CCR5 Co-receptor Trofile Assay
    • Once per individual.
  • HLA B5701 (Abacavir Hypersensitivity)
    • Once per individual.

Reimbursement requests shall be submitted only for tests that conform to current recommendations for AIDS/HIV disease management and antiretroviral resistance testing in pediatric, adolescent and adult populations.

Last Revised: March 04, 2014