Presemptive Eligibility Program Benefits

Effective for dates of service on or after September 1, 2007, the following procedure codes are benefits of the Presumptive Eligibility (PE) program:

• 80101 Drug screen, qualitative; single drug class method
• 86703 Antibody, HIV-1 and HIV-2, single assay
• 87086 Culture, bacterial; quantitative colony count, urine
• 87088 Culture, bacterial; with isolation and presumptive identification of each isolate, urine
• 87186 Susceptibility studies, antimicrobial agent; microdilution or agar dilution

Pregnant women should be screened for asymptomatic bacteriuria at 12 to 16 weeks of gestation with codes 87086, 87088 and 87186. PE providers must not bill bacteriuria testing for pregnant women with CPT-4 code 81007 (urinalysis; bacteriuria screen, except by culture or dipstick.)