Urine culture that counts bacterial colonies per milliliter to show whether a urinary tract infection is present.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Urinary symptoms or abnormal urinalysis result
- Collection method, such as clean catch or catheter
- Post-operative day if after surgery
- Diagnosis code for suspected UTI or the urinary symptom
- Planned surgery if ordered pre-operatively
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
87086 reports a quantitative urine culture with colony count. It tells you whether bacteria are present in urine and at what level. Identification of the organism is a separate code (87088), and susceptibility testing is separate again.
Orthopedic practices see urine cultures in two places. Before a total joint, some programs screen urine when the patient has symptoms or a positive urinalysis. After surgery, a urinary infection is a common cause of post-op fever and confusion in older hip fracture patients. Routine urine culture in a pre-op patient with no symptoms is no longer standard in many joint programs, and payers may push back on it.
The lab bills 87086 under the Clinical Laboratory Fee Schedule. Denials tend to follow two patterns: culture ordered with no symptoms or abnormal urinalysis, and identification billed as part of 87086 when it should go on its own line. Use a symptom or UTI diagnosis code rather than the joint diagnosis.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
Common denial reasons
The recurring reasons claims for CPT 87086 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- No symptoms or abnormal urinalysis documented
- Diagnosis is the joint condition rather than a urinary indication
- Identification billed as part of 87086 instead of 87088
- Duplicate culture already done by the hospital
- Billed by the ordering practice instead of the lab
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Does 87086 include organism identification?
02Is a urine culture required before joint replacement?
03What diagnosis code supports a urine culture?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02CMS Clinical Laboratory Fee Schedule 2026
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
Mira Scribe
Mira Scribe captures urinary symptoms and post-op fever history the patient reports, which gives the urine culture a documented reason beyond the surgical diagnosis.
See how Mira captures CPT 87086 documentation