Culture, Urine, Bacterial National Coverage Determination

Culture, Urine, Bacterial

National Coverage Determination

CPT Codes:

Code 87086 87088

Code A02.1 A18.14 A34 A40.0 A40.1 A40.3 A40.8 A40.9 A41.01 A41.02 A41.1 A41.2 A41.3 A41.4 A41.50 A41.51 A41.52 A41.53 A41.59 A41.81 A41.89 A41.9 A42.7 A56.01 A56.02 A56.11 D65 D70.0 D70.1 D70.2 D70.3 D70.4 D70.8 D70.9 D72.89 E09.21 E09.22 E09.29 E11.10 E11.11 E87.2 E87.4 F45.8

Description Culture, bacterial; quantitative, colony count, urine. Culture, bacterial; with isolation and presumptive identification of each isolates, urine.

Description Salmonella sepsis Tuberculosis of prostate Obstetrical tetanus Sepsis due to streptococcus, group A Sepsis due to streptococcus, group B Sepsis due to Streptococcus pneumoniae Other streptococcal sepsis Streptococcal sepsis, unspecified Sepsis due to Methicillin susceptible Staphylococcus aureus Sepsis due to Methicillin resistant Staphylococcus aureus Sepsis due to other specified staphylococcus Sepsis due to unspecified staphylococcus Sepsis due to Hemophilus influenzae Sepsis due to anaerobes Gram-negative sepsis, unspecified Sepsis due to Escherichia coli [E. coli] Sepsis due to Pseudomonas Sepsis due to Serratia Other Gram-negative sepsis Sepsis due to Enterococcus Other specified sepsis Sepsis, unspecified organism Actinomycotic sepsis Chlamydial cystitis and urethritis Chlamydial vulvovaginitis Chlamydial female pelvic inflammatory disease Disseminated intravascular coagulation [defibrination syndrome] Congenital agranulocytosis Agranulocytosis secondary to cancer chemotherapy Other drug-induced agranulocytosis Neutropenia due to infection Cyclic neutropenia Other neutropenia Neutropenia, unspecified Other specified disorders of white blood cells Drug or chemical induced diabetes mellitus with diabetic nephropathy Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease Drug or chemical induced diabetes mellitus with other diabetic kidney complication Type 2 diabetes mellitus with ketoacidosis without coma Type 2 diabetes mellitus with ketoacidosis with coma Acidosis Mixed disorder of acid-base balance Other somatoform disorders

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective April 1, 2018

Medicare Limited Coverage Tests

Culture, Urine, Bacterial

National Coverage Determination

Code G93.3 I50.814 I50.82 I50.84 I50.89 J80 K72.00 K72.01 K76.2 M04.1 M32.14 M32.15 M35.04 M54.89 M54.9 N00.0 N00.1 N00.2 N00.3 N00.4 N00.5 N00.6 N00.7 N00.8 N00.9 N01.0 N01.1 N01.2 N01.3 N01.4 N01.5 N01.6 N01.7 N01.8 N01.9 N05.0 N05.1 N05.2 N05.3 N05.4 N05.5 N05.6 N05.7 N05.8 N05.9 N06.0 N06.1 N06.2 N06.3

Description Postviral fatigue syndrome Right heart failure due to left heart failure Biventricular heart failure End stage heart failure Other heart failure Acute respiratory distress syndrome Acute and subacute hepatic failure without coma Acute and subacute hepatic failure with coma Central hemorrhagic necrosis of liver Periodic fever syndromes Glomerular disease in systemic lupus erythematosus Tubulo-interstitial nephropathy in systemic lupus erythematosus Sicca syndrome with tubulo-interstitial nephropathy Other dorsalgia Dorsalgia, unspecified Acute nephritic syndrome with minor glomerular abnormality Acute nephritic syndrome with focal and segmental glomerular lesions Acute nephritic syndrome with diffuse membranous glomerulonephritis Acute nephritic syndrome with diffuse mesangial proliferative glomerulonephritis Acute nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis Acute nephritic syndrome with diffuse mesangiocapillary glomerulonephritis Acute nephritic syndrome with dense deposit disease Acute nephritic syndrome with diffuse crescentic glomerulonephritis Acute nephritic syndrome with other morphologic changes Acute nephritic syndrome with unspecified morphologic changes Rapidly progressive nephritic syndrome with minor glomerular abnormality Rapidly progressive nephritic syndrome with focal and segmental glomerular lesions Rapidly progressive nephritic syndrome with diffuse membranous glomerulonephritis Rapidly progressive nephritic syndrome with diffuse mesangial proliferative glomerulonephritis Rapidly progressive nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis Rapidly progressive nephritic syndrome with diffuse mesangiocapillary glomerulonephritis Rapidly progressive nephritic syndrome with dense deposit disease Rapidly progressive nephritic syndrome with diffuse crescentic glomerulonephritis Rapidly progressive nephritic syndrome with other morphologic changes Rapidly progressive nephritic syndrome with unspecified morphologic changes Unspecified nephritic syndrome with minor glomerular abnormality Unspecified nephritic syndrome with focal and segmental glomerular lesions Unspecified nephritic syndrome with diffuse membranous glomerulonephritis Unspecified nephritic syndrome with diffuse mesangial proliferative glomerulonephritis Unspecified nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis Unspecified nephritic syndrome with diffuse mesangiocapillary glomerulonephritis Unspecified nephritic syndrome with dense deposit disease Unspecified nephritic syndrome with diffuse crescentic glomerulonephritis Unspecified nephritic syndrome with other morphologic changes Unspecified nephritic syndrome with unspecified morphologic changes Isolated proteinuria with minor glomerular abnormality Isolated proteinuria with focal and segmental glomerular lesions Isolated proteinuria with diffuse membranous glomerulonephritis Isolated proteinuria with diffuse mesangial proliferative glomerulonephritis

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective April 1, 2018

Medicare Limited Coverage Tests

Culture, Urine, Bacterial

National Coverage Determination

Code N06.4 N06.5 N06.6 N06.7 N06.8 N06.9 N07.0 N07.1 N07.2 N07.3 N07.4 N07.5 N07.6 N07.7 N07.8 N07.9 N08 N10 N11.0 N11.1 N11.8 N11.9 N12 N13.0 N13.1 N13.2 N13.4 N13.5 N13.6 N13.70 N13.71 N13.721 N13.722 N13.729 N13.731 N13.732 N13.739 N13.8 N13.9 N14.0 N14.1 N14.2 N14.3 N14.4 N15.0 N15.1 N15.8 N15.9

Description Isolated proteinuria with diffuse endocapillary proliferative glomerulonephritis Isolated proteinuria with diffuse mesangiocapillary glomerulonephritis Isolated proteinuria with dense deposit disease Isolated proteinuria with diffuse crescentic glomerulonephritis Isolated proteinuria with other morphologic lesion Isolated proteinuria with unspecified morphologic lesion Hereditary nephropathy, not elsewhere classified with minor glomerular abnormality Hereditary nephropathy, not elsewhere classified with focal and segmental glomerular lesions Hereditary nephropathy, not elsewhere classified with diffuse membranous glomerulonephritis Hereditary nephropathy, not elsewhere classified with diffuse mesangial proliferative Hereditary nephropathy, not elsewhere classified with diffuse endocapillary proliferative Hereditary nephropathy, not elsewhere classified with diffuse mesangiocapillary Hereditary nephropathy, not elsewhere classified with dense deposit disease Hereditary nephropathy, not elsewhere classified with diffuse crescentic glomerulonephritis Hereditary nephropathy, not elsewhere classified with other morphologic lesions Hereditary nephropathy, not elsewhere classified with unspecified morphologic lesions Glomerular disorders in diseases classified elsewhere Acute pyelonephritis Nonobstructive reflux-associated chronic pyelonephritis Chronic obstructive pyelonephritis Other chronic tubulo-interstitial nephritis Chronic tubulo-interstitial nephritis, unspecified Tubulo-interstitial nephritis, not specified as acute or chronic Hydronephrosis with ureteropelvic junction obstruction Hydronephrosis with ureteral stricture, not elsewhere classified Hydronephrosis with renal and ureteral calculous obstruction Hydroureter Crossing vessel and stricture of ureter without hydronephrosis Pyonephrosis Vesicoureteral-reflux, unspecified Vesicoureteral-reflux without reflux nephropathy Vesicoureteral-reflux with reflux nephropathy without hydroureter, unilateral Vesicoureteral-reflux with reflux nephropathy without hydroureter, bilateral Vesicoureteral-reflux with reflux nephropathy without hydroureter, unspecified Vesicoureteral-reflux with reflux nephropathy with hydroureter, unilateral Vesicoureteral-reflux with reflux nephropathy with hydroureter, bilateral Vesicoureteral-reflux with reflux nephropathy with hydroureter, unspecified Other obstructive and reflux uropathy Obstructive and reflux uropathy, unspecified Analgesic nephropathy Nephropathy induced by other drugs, medicaments and biological substances Nephropathy induced by unspecified drug, medicament or biological substance Nephropathy induced by heavy metals Toxic nephropathy, not elsewhere classified Balkan nephropathy Renal and perinephric abscess Other specified renal tubulo-interstitial diseases Renal tubulo-interstitial disease, unspecified

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective April 1, 2018

Medicare Limited Coverage Tests

Culture, Urine, Bacterial

National Coverage Determination

Code N16 N17.1 N17.2 N18.6 N20.0 N20.1 N20.2 N20.9 N21.1 N21.8 N21.9 N22 N23 N28.0 N28.1 N28.81 N28.82 N28.83 N28.84 N28.85 N28.86 N28.89 N28.9 N29 N30.00 N30.01 N30.10 N30.11 N30.20 N30.21 N30.30 N30.31 N30.40 N30.41 N30.80 N30.81 N30.90 N30.91 N34.0 N34.1 N34.2 N34.3 N35.111 N35.112 N35.113 N35.114 N35.119 N35.12 N37

Description Renal tubulo-interstitial disorders in diseases classified elsewhere Acute kidney failure with acute cortical necrosis Acute kidney failure with medullary necrosis End stage renal disease Calculus of kidney Calculus of ureter Calculus of kidney with calculus of ureter Urinary calculus, unspecified Calculus in urethra Other lower urinary tract calculus Calculus of lower urinary tract, unspecified Calculus of urinary tract in diseases classified elsewhere Unspecified renal colic Ischemia and infarction of kidney Cyst of kidney, acquired Hypertrophy of kidney Megaloureter Nephroptosis Pyelitis cystica Pyeloureteritis cystica Ureteritis cystica Other specified disorders of kidney and ureter Disorder of kidney and ureter, unspecified Other disorders of kidney and ureter in diseases classified elsewhere Acute cystitis without hematuria Acute cystitis with hematuria Interstitial cystitis (chronic) without hematuria Interstitial cystitis (chronic) with hematuria Other chronic cystitis without hematuria Other chronic cystitis with hematuria Trigonitis without hematuria Trigonitis with hematuria Irradiation cystitis without hematuria Irradiation cystitis with hematuria Other cystitis without hematuria Other cystitis with hematuria Cystitis, unspecified without hematuria Cystitis, unspecified with hematuria Urethral abscess Nonspecific urethritis Other urethritis Urethral syndrome, unspecified Postinfective urethral stricture, not elsewhere classified, male, meatal Postinfective bulbous urethral stricture, not elsewhere classified Postinfective membranous urethral stricture, not elsewhere classified Postinfective anterior urethral stricture, not elsewhere classified Postinfective urethral stricture, not elsewhere classified, male, unspecified Postinfective urethral stricture, not elsewhere classified, female Urethral disorders in diseases classified elsewhere

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective April 1, 2018

Medicare Limited Coverage Tests

Culture, Urine, Bacterial

National Coverage Determination

Code N39.0 N39.3 N39.41 N39.42 N39.43 N39.44 N39.45 N39.46 N39.490 N39.498 N40.0 N40.1 N40.2 N40.3 N41.0 N41.1 N41.2 N41.3 N41.4 N41.8 N41.9 N42.0 N42.1 N42.3 N42.30 N42.31 N42.32 N42.39 N42.81 N42.82 N42.83 N42.89 N42.9 N43.40 N43.41 N43.42 N44.00 N44.01 N44.02 N44.03 N44.04 N44.1 N44.2 N44.8 N45.1 N45.2 N45.3 N45.4

Description Urinary tract infection, site not specified Stress incontinence (female) (male) Urge incontinence Incontinence without sensory awareness Post-void dribbling Nocturnal enuresis Continuous leakage Mixed incontinence Overflow incontinence Other specified urinary incontinence Benign prostatic hyperplasia without lower urinary tract symptoms Benign prostatic hyperplasia with lower urinary tract symptoms Nodular prostate without lower urinary tract symptoms Nodular prostate with lower urinary tract symptoms Acute prostatitis Chronic prostatitis Abscess of prostate Prostatocystitis Granulomatous prostatitis Other inflammatory diseases of prostate Inflammatory disease of prostate, unspecified Calculus of prostate Congestion and hemorrhage of prostate Dysplasia of prostate Unspecified dysplasia of prostate Prostatic intraepithelial neoplasia Atypical small acinar proliferation of prostate Other dysplasia of prostate Prostatodynia syndrome Prostatosis syndrome Cyst of prostate Other specified disorders of prostate Disorder of prostate, unspecified Spermatocele of epididymis, unspecified Spermatocele of epididymis, single Spermatocele of epididymis, multiple Torsion of testis, unspecified Extravaginal torsion of spermatic cord Intravaginal torsion of spermatic cord Torsion of appendix testis Torsion of appendix epididymis Cyst of tunica albuginea testis Benign cyst of testis Other noninflammatory disorders of the testis Epididymitis Orchitis Epididymo-orchitis Abscess of epididymis or testis

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective April 1, 2018

Medicare Limited Coverage Tests

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