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    v1.0.31
    OpenPayerPolicy UpdatesUrologyAetna broth culture testing Coverage Update | Open…
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    CurrentAetnaPolicy 0695

    Broth Culture Testing for Interstitial Cystitis

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    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.

    Policy Summary
    PayerAetna
    PolicyBroth Culture Testing for Interstitial Cystitis
    Policy CodePolicy 0695
    Change TypeNo material change
    Effective DateDec 21, 2004
    Last ReviewSep 15, 2023
    Next Review DateJul 25, 2024
    Key ActionDo not order broth culture testing for interstitial cystitis because Aetna considers it experimental and investigational and it may be denied.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    0695Aetna policy number
    2004-12-21Effective date
    09/15/2023

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Last review
    07/25/2024Next review
    N30.10-N30.11ICD-10 codes listed

    Coverage Criteria

    Experimental and Investigational

    Policy coverage statement: Aetna considers broth culture testing for interstitial cystitis experimental and investigational because there is inadequate evidence of the effectiveness of this test in the diagnosis and management of interstitial cystitis.

    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

    CPT / HCPCS / ICD-10 Codes referenced in policymixed
    87086Culture, bacterial; quantitative colony count, urine
    87088with isolation and presumptive identification of each isolate, urine
    87181-87190Susceptibility studies, antimicrobial agents
    P7001Culture, bacterial, urine; quantitative, sensitivity study
    N30.10-N30.11Interstitial cystitis (chronic)

    Provider Actions & Billing

    Denial Risk

    Experimental / Investigational — Denial Risk

    Broth culture testing for interstitial cystitis is designated experimental and investigational by the payer; this designation may lead to denial of coverage for such testing.

    • Affected CPT/HCPCS codes include: 87086, 87088, 87181-87190, P7001.
    • ICD-10 codes referenced in the policy: N30.10 - N30.11 (Interstitial cystitis).
    Prior Authorization

    Prior Authorization

    No prior authorization requirements are specified in the source content for broth culture testing in this policy.

    Background

    Interstitial cystitis (IC) is a chronic bladder disorder of uncertain etiology characterized primarily by urinary urgency, frequency, and bladder pain. It is generally a diagnosis of exclusion based on symptom assessment and, when used, cystoscopy or biopsy. Some investigators have proposed specialized broth culture techniques to identify bacteria not detected by standard urine cultures, but major clinical reviews and guideline bodies do not support a bacterial cause for IC and do not endorse broth culture testing for routine diagnosis or management.

    Definitions

    Interstitial cystitis (IC) — key features
    DefinitionA treatable but essentially incurable chronic bladder condition of unknown etiology characterized by urinary urgency, frequency, and bladder pain.
    EtiologyUnknown; most evidence does not support a bacterial cause for IC.
    DiagnosisPrimarily a diagnosis of exclusion based on symptoms, cystoscopic findings, and bladder biopsy when necessary.
    Antibiotic responseMedical tests typically reveal no organisms in urine and antibiotic therapy has shown no therapeutic benefit for IC.
    Broth culture testing (extraordinary/pure-culture broth methods) — definition
    Method descriptionA laboratory technique based on pure-culture broth technology that initially incubates urine specimens in liquid broth to allow growth of microbial strains which are then transferred to differential media for isolation and identification.

    Revision History

    2004-12-21policy_effective

    Policy became effective.

    2023-09-15last_reviewLatest

    Policy was last reviewed.

    2024-07-25next_review

    Next scheduled review date for the policy.

    Policy Summary
    PayerAetna
    PolicyBroth Culture Testing for Interstitial Cystitis
    Policy CodePolicy 0695
    Change TypeNo material change
    Effective DateDec 21, 2004
    Last ReviewSep 15, 2023
    Next Review DateJul 25, 2024
    Key ActionDo not order broth culture testing for interstitial cystitis because Aetna considers it experimental and investigational and it may be denied.
    SourceLink
    On This Page
    Coverage CriteriaCodingProvider Actions & BillingBackgroundDefinitionsRevision History
    Step Therapy

    Step Therapy

    No step therapy requirements are specified in the source content for broth culture testing in this policy.

    Documentation Required

    Documentation Requirements

    No documentation requirements are specified in the source content for broth culture testing in this policy.

    Note

    Policy Scope

    This bulletin addresses broth culture testing for interstitial cystitis and states that such testing is considered experimental and investigational; providers should be aware testing may not be covered for this indication.

    Note

    Provider Actions (Reserved)

    Provider action: reserved (no additional provider actions were specified in the source content).

    Denial Risk

    Denial Triggers

    No specific denial triggers (beyond the investigational designation) are stated in the source content.

    Proposed useInvestigators have proposed the method to detect organisms not found with standard culture techniques and to support a hypothesized gram-positive bacterial etiology for IC.
    Evidence statusResults from proponents (a team of Virginia researchers) have not been published; peer-reviewed literature does not support a bacterial origin for IC.
    Clinical implicationBecause an infectious etiology for IC is not convincingly supported, the broth culturing method remains investigational for diagnosis or management of IC.