Anthem Blue Cross Connecticut CG-LAB-24 Outpatient Urine Culture Form

This document addresses outpatient urine culture testing for bacteria.

Clinical Indications

Medically Necessary:

Outpatient urine culture testing for bacteria is considered medically necessary to evaluate any of the following situations:

1. Clinical signs or symptoms suggesting urinary tract infection (UTI); or
2. Abnormal urinalysis suggesting UTI; or
3. Asymptomatic bacteriuria in pregnant persons; or
4. Bacteriuria in individuals prior to undergoing an endoscopic urologic procedure; or
5. Suspected interstitial cystitis or bladder pain syndrome.

Not Medically Necessary:

Outpatient urine culture testing for bacteria is considered not medically necessary when the above criteria are not met and for all other situations.