Urinalysis Billing with Pregnancy Diagnosis

Effective September 1, 2009, when a urinalysis (CPT-4 codes 81000 – 81099) is billed with a pregnancy ICD-9-CM diagnosis code, it may be reimbursed if billed in conjunction with another diagnosis code other than V70.0, V70.5 – V70.9, V72.0, V72.11 – V72.19, V72.6 or V72.9. A pregnancy diagnosis code must be present on the claim form for reimbursement when a recipient’s eligibility is restricted to pregnancy-only Medi-Cal. Providers are reminded that claims for routine urinalysis with a diagnosis related to pregnancy are denied. A diagnosis code that establishes the medical necessity of the urinalysis must also be present on the claim form to allow reimbursement, as outlined above.