Urine Culture Cost and Medicare Coverage (CPT 87086)

Also called: bacterial urine culture · urine culture and sensitivity · urine C&S · culture, urine, routine — all the same test, CPT 87086 (related code: 87088).

The short answer

Covered when there is a reason to suspect an infection. Medicare’s national policy (NCD 190.12, the same in every state) covers a urine culture when you have symptoms of a urinary tract infection, when a urinalysis came back abnormal, when a fever or a body-wide infection has no obvious source, before major surgery on the kidneys, bladder, or prostate, and for kidney-transplant patients on immune-suppressing drugs.

What is not covered is a culture with no symptoms and no abnormal finding behind it. The policy calls that screening, and Medicare does not pay for screening urine cultures. It also says a “test of cure” after an ordinary, uncomplicated infection is generally not needed.

A urine culture is usually two codes, not one. 87086 is the culture itself. If bacteria grow, the lab adds 87088 for each organism it identifies, and may add identification and antibiotic-sensitivity codes on top. All of them fall under the same coverage rule.

When Medicare DOES cover it

The national policy lists six situations. In plain English:

• An abnormal urinalysis that points to infection: blood, white cells, or bacteria in the urine, or a positive leukocyte esterase or nitrite strip. A urinalysis usually comes first, and many labs run the culture automatically (“reflex”) when the urinalysis is abnormal, but the policy says a urinalysis is not required before a culture.
• Symptoms of a urinary tract infection: urgency, frequency, getting up at night to urinate, burning or pain, discharge, or new incontinence. For an upper (kidney) infection, add fever, chills, fatigue, or pain in the side, abdomen, or pelvis. The policy notes that older adults and people with neurologic conditions may show an infection differently, for example as sudden confusion, general weakness, or a decline in function.
• A suspected infection with no clear source: possible urosepsis, fever of unknown origin, or a body-wide infection.
• Checking whether treatment worked, but only when there is a complication such as a structural or functional urinary abnormality, stones, a foreign body, a stent, or signs that the infection is not responding. For an uncomplicated infection, the policy says a repeat culture is generally not indicated.
• Before major urinary-tract surgery: kidney transplant, kidney-stone procedures, or surgery through the urethra on the bladder or prostate.
• Kidney-transplant recipients on immune-suppressing drugs, to catch a hidden infection.

The diagnosis code list behind this policy is about 760 codes: urinary tract infection, cystitis, kidney infection, painful or frequent urination, blood or bacteria or white cells found in urine, fever, enlarged prostate with urinary symptoms, obstructive uropathy, a urinary stoma, and problems with an indwelling catheter. If one of these genuinely describes your situation, the diagnosis for it belongs on your doctor’s order, and coverage follows.

When Medicare does NOT cover it

• No symptoms and no abnormal finding. The policy is direct: testing for bacteria in the urine of someone with no symptoms is screening and is not covered. It adds that the U.S. Preventive Services Task Force found no basis for screening older adults, including people with diabetes, outside pregnancy.
• A routine “test of cure” after an uncomplicated infection that responded to treatment.
• A second 87086 in the same visit. The policy allows the base culture code once per encounter. (The 87088 add-on can be billed more than once, because an infection can involve more than one organism.)
• A wellness visit or a general check-up with nothing urinary on the order; a past history of infections on its own is not on the covered list either.

(Never ask anyone to change a code just to get coverage; that is fraud. But doctors often have a legitimate reason for the test that simply wasn’t written down.)

What you pay if it IS covered: $0

Covered lab tests cost Medicare patients nothing, with no deductible and no 20% coinsurance. Medicare pays the lab $8.07 for the culture (87086) and $8.09 for each organism it identifies (87088), and you owe zero.

What you pay if it is NOT covered, read this before you sign

Quest’s own test directory flags the urine culture as “subject to a Medicare Limited Coverage Policy” that “may require a signed ABN when ordering.” If a culture is on your order without symptoms or an abnormal urinalysis behind it, expect the Advance Beneficiary Notice (ABN), the signature pad, committing you to the lab’s own billing rates if Medicare denies the claim. Before you sign:

1. Ask the lab to print exactly what you would owe. You’re entitled to see the number in black and white first. For perspective: when Medicare covers this test, it pays the lab $8.07 for the culture.
2. Ask what the add-ons cost. If bacteria grow, the lab adds 87088 per organism, then identification and sensitivity testing, each at its own price. An ABN quote for “a urine culture” may not include them. Ask for the all-in figure.
3. Know the direct prices: a urine culture sells for $20 at Jason Health (jasonhealth.com, plus their flat $18 lab-collection fee per order, so $38 all in). The full table is above. Fewer sellers carry this test than carry blood tests: Quest’s consumer site, Labcorp OnDemand, and Personalabs sell a urinalysis but not a culture. Note that a culture is a sample you give at the lab, so the collection fee still applies even though no blood is drawn, and if bacteria grow, the identification and sensitivity add-ons are charged on top.

Before you sign the pad, 60-second checklist

1. Ask: “Can you print what I’ll owe if Medicare doesn’t pay, including any add-on tests if something grows?”
2. Ask your doctor: “Is this because of my symptoms or my urinalysis, or is it a routine check?” A routine check with no symptoms is the one Medicare calls screening.
3. Compare the printed price to the direct-purchase prices before deciding how to proceed.

What counts as a “normal” urine culture

There is no number range for this test. A culture reports one of two things: no significant growth, which MedlinePlus and Cleveland Clinic both describe as a normal or negative result meaning no infection; or the name of the organism that grew, how much of it (a colony count), and a table of which antibiotics it is susceptible or resistant to.

Labs set their own reporting threshold. Labcorp, for example, reports up to two organisms at levels above 10,000 colonies per milliliter and runs identification and sensitivity only when the culture warrants it. Small amounts of mixed skin bacteria usually mean the sample picked up contamination on the way into the cup, which is why the clean-catch steps matter.

(Where lab ranges and “optimal” ranges come from, and who decides.)

This page can tell you what the report contains. It cannot tell you what yours means; that reading belongs to your doctor, alongside your symptoms and your other results.

Quick questions people ask

What is a urine culture? A lab test that checks a urine sample for bacteria or yeast by giving them a place to grow for a day or two. It is the test that tells your doctor which germ is causing a urinary tract infection and which antibiotics work against it. On billing paperwork the culture is CPT 87086, and each organism identified adds 87088.

How long does a urine culture take? Cultures need 24 to 48 hours to grow and may take up to three or four days to report. Our guide on urine culture turnaround explains why it is slower than a urinalysis and what to do while you wait.

Is a urinalysis the same as a urine culture? No. A urinalysis is a quick chemical and microscope check that can suggest an infection in minutes. A culture confirms it and names the organism. Many labs run “urinalysis with reflex to culture,” where the culture is added automatically, at its own charge, when the urinalysis shows white cells, leukocyte esterase, nitrite, bacteria, or yeast.

How do you give a clean-catch sample? Wash your hands, clean the area with the wipe from the kit (front to back for women; for men, clean the tip and pull back the foreskin first if uncircumcised), start urinating into the toilet, then catch the middle of the stream in the sterile cup, and finish in the toilet. MedlinePlus suggests collecting when urine has been in the bladder for two to three hours, and Labcorp says a first-morning sample is best. Touching the inside of the cup or lid is the usual reason a sample comes back as “mixed flora” and has to be repeated.

Can a urine culture be done from a catheter? Yes, from a sample drawn through the catheter into a sterile container. Labs will not accept the catheter tip itself or urine from a collection bag.

Sources and data dates

Medicare payment amounts: CMS Clinical Laboratory Fee Schedule, 2026 Q3 file (national rates for 87086 and 87088). Coverage rules: CMS Medicare Coverage Database, NCD 190.12 (Urine Culture, Bacterial), a national policy identical in every state, and the same text in the NCD Manual, Chapter 1, Part 3. Test descriptions and collection: MedlinePlus Medical Encyclopedia (urine culture; clean catch urine sample), Cleveland Clinic, Quest tests 395 and 3020, Labcorp test 008847. Consumer prices checked September 2026. Information current as of the date shown above; coverage is always determined by Medicare when your claim is processed.

ClaraCover provides information, not medical, billing, or insurance advice. Talk to your doctor about what tests you need.