A02.25 — Salmonella pyelonephritis
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Outpatient urine culture testing for bacteria is consideredmedically necessaryto evaluate any of the following situations:
- Clinical signs or symptoms suggesting urinary tract infection (UTI);or
- Abnormal urinalysis suggesting UTI;or
- Asymptomatic bacteriuria in pregnant persons;or
- Bacteriuria in individuals prior to undergoing an endoscopic urologic procedure;or
- Suspected interstitial cystitis or bladder pain syndrome.
1 Active Policy
ANTHEM-CG-LAB-24 — CG-LAB-24 Outpatient Urine Culture
Related Codes
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