New Medical Policy: Urine Culture Testing for Bacteria

New Medical Policy: Urine Culture Testing for Bacteria

9/18/18

Bacteriuria is the presence of bacteria in the urine. Typically, bacteriuria and pyuria are present and can be both symptomatic and asymptomatic Urinary Tract Infections (UTls).  A UTI can occur in the urinary system and can include cystitis, pyelonephritis, urosepsis, urethritis, bacterial prostatitis, and epididymitis. A urine culture can be performed to determine the presence of bacteria and to characterize the bacterial infection.

Effective Dec. 1, 2018, BlueCross® BlueShield® of South Carolina and BlueChoice HealthPlan will implement a new medical policy addressing urine testing for bacteria. The policy, CAM 206 – Urine Culture Testing for Bacteria, has been published on the Medical Policies pages of the BlueCross and BlueChoice® websites.

A portion of the policy reads:

  1. In pregnant women, urinalysis and urine culture testing (with isolate identification and antibiotic susceptibilities, if applicable) for any urinary tract infection, asymptomatic or symptomatic, is considered medically necessary. 
  2. For asymptomatic patients prior to undergoing urological interventions breaching the mucosa, urinalysis and urine culture testing (with isolate identification and antibiotic susceptibilities, if applicable) is considered medically necessary.
  3. For asymptomatic urinary tract infection or asymptomatic bacteriuria in all other instances, urine culture testing (with isolate identification and antibiotic susceptibilities, if applicable) is considered NOT medically necessary.
     

For complete information about CAM 206, to include a list of the procedure codes to be used as a general reference tool, visit our Medical Policies page. Please also remember medical necessity is not a guarantee of payment. Payment is subject to the member’s plan coverage at the time the service is performed. You may contact Provider Education by using the Provider Education Contact Form or by calling 803-264-4730 with additional questions.

BlueChoice® HealthPlan of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.