Laboratory - Urine Culture Testing for Bacteria
Payment policy governing reimbursement for urine culture testing codes for Humana Medicare Advantage products; describes when tests are not reimbursable and references applicable Medicare LCDs and clinical guidance. Affects providers submitting claims for urine culture and related microbiology services for Humana Medicare Advantage members.
No material clinical or coverage changes in this revision.
Coverage Criteria and References
Coverage criteria and references
Stated coverage position and external references
ALL of the following
- Urine culture testing (CPT codes 87076, 87077, 87140, 87147, 87149, 87181, and 87186) will not be reimbursed when billed with a primary diagnosis representing a general encounter without abnormal findings or similar examination.
ALL of the following
- Procedure code 87149 (identification by nucleic acid probe) is subject to Original Medicare Local Coverage Determinations (LCDs) and related MolDX guidance from multiple Medicare Administrative Contractors (CGS, Noridian, Palmetto GBA, and WPS) as listed in the policy.
ALL of the following
- Medicare Advantage payment policies apply except when a procedure has established criteria through the Original Medicare LCDs referenced in this policy; claims remain subject to medical necessity, reasonableness, and applicable referral or authorization requirements.
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