CommercialCoverageMedium impact
Broth Culture Testing for Interstitial Cystitis (CPB 0695, reviewed 2025-11-24)
Aetna·Urology, Internal Medicine, Infectious Disease·Medical Policy
Effective date
Nov 24, 2025
We identified it
Aug 14, 2026
Summary
Aetna has classified broth culture testing for interstitial cystitis (CPB 0695) as experimental, investigational, or unproven, effective immediately. This means claims for broth culture tests used to diagnose or manage interstitial cystitis will be denied for all patients with ICD-10 codes N30.10 or N30.11. Billing teams must implement claim denial protocols and educate providers that standard urine culture codes (87086, 87088) and related susceptibility codes are not covered when billed for IC diagnosis.
Action Required
Effective immediately (2025-11-24): Billing team must implement system edits to deny or flag claims for CPT codes 87086, 87088, 87181-87190, and HCPCS code P7001 when linked to ICD-10 codes N30.10 or N30.11 (interstitial cystitis). Update claim scrubbing rules in billing software to automatically reject these code combinations with denial reason: 'Broth culture testing for interstitial cystitis is considered experimental and is not covered.' Notify all urology and internal medicine providers in writing that broth culture tests for IC diagnosis are non-covered services; patients may be billed directly if they sign an Advanced Beneficiary Notice (ABN). Train front-desk and billing staff to inform patients in advance that these tests are not covered. Monitor for appeal submissions and prepare template denial letters citing Aetna CPB 0695.