Broth Culture Testing for Interstitial Cystitis
This policy governs the use and coverage stance for broth culture testing intended to diagnose or manage interstitial cystitis and applies to Aetna members and participating providers.
No material clinical or coverage changes in this revision.
Coverage Criteria
Experimental and Investigational
From policy statement
Aetna considers broth culture testing for interstitial cystitis to be experimental and investigational because there is inadequate evidence that the test is effective for the diagnosis or management of interstitial cystitis. The policy specifically lists the ICD-10 codes N30.10–N30.11 (interstitial cystitis, chronic) in association with this coverage stance.
Because the peer-reviewed evidence does not demonstrate clinical benefit for broth culture methods in this indication, the procedure is labeled investigational and is not supported for routine clinical use in members with suspected or diagnosed interstitial cystitis. As a result, claims for broth culture testing performed for this indication may be denied as not medically necessary under this policy.
Coding
| 87086 | Culture, bacterial; quantitative colony count, urine |
| 87088 | with isolation and presumptive identification of each isolate, urine |
| 87181-87190 | Susceptibility studies, antimicrobial agents |
| P7001 | Culture, bacterial, urine; quantitative, sensitivity study |
| N30.10-N30.11 | Interstitial cystitis (chronic) |
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