Bacterial Urine Culture Lab Tests
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What’s Changed?
We updated the improper payment rate and denial reasons for the 2024 reporting period.
Affected Providers
Physicians and non-physician practitioners who write prescriptions or orders for bacterial urine culture lab tests.
HCPCS & CPT Codes
National Coverage Determination (NCD): Urine Culture, Bacterial (190.12) has the current HCPCS and CPT codes.
Background
According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rate for bacterial urine culture lab tests is 16.2%, with a projected improper payment amount of $9 million.
A bacterial urine culture is a lab test performed on a urine specimen to establish the probable cause of a presumed urinary tract infection. It’s common practice to do a urinalysis before a urine culture. You may also use a patient’s urine culture as part of the evaluation and management of another related condition.
You must meet the provisions in NCD 190.12.
Denial Reasons
Insufficient documentation accounted for 100% of improper payments for bacterial urine culture lab tests during the 2024 reporting period.
Preventing Denials
You must meet specific requirements when ordering diagnostic lab tests. The physician's request may be made through clearly documented and communicated laboratory protocols.
Disclaimers
Page Last Modified:
11/25/2025 12:27 PM