Payer PolicyActive
Broth Culture Testing for Interstitial Cystitis
AETNA-CPB-0695
Aetna
Effective: September 15, 2023
Updated: December 6, 2025
created · Dec 2, 2025
Policy Summary
Aetna considers broth culture testing for interstitial cystitis (IC; ICD-10 N30.10–N30.11) experimental/investigational and does not cover it for diagnosis or management. This determination is based on inadequate evidence of effectiveness and lack of support in major guidelines and reviews (e.g., AUA, UpToDate) showing no proven infectious etiology or benefit from antibiotics in typical IC.
Coverage Criteria Preview
Key requirements from the full policy
"ICD-10 codes not covered for indications listed in the CPB: N30."
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