Does CMS provide a list of the conditions that it considers medically necessary for a urinalysis?


There are many examples of when urinalysis is considered medically necessary by the Medicare Program. However, the best thing is to verify coverage of pre-operative testing with the individual payers. Most payers have reimbursement policies and list the tests that are non-covered when ordered as a screening procedure prior to surgery.

Also remember to document lab tests with signs and symptoms or ICD-10 information concerning the reason the test is being performed, not the post-test diagnosis. It is inappropriate for laboratory personnel to use post-test diagnosis for addition of reflex tests unless the treating physician has reviewed the initial result and provided in writing the additional diagnosis.

This question was answered in the 2018 edition of our Coding Essentials for Laboratories. For more hot topics relating to laboratory services, please view our store, or call us at 1.800.252.1578 ext. 2.


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