UCR 284: UTI PCR Under Fire – OIG Scrutiny, Denials, and What to Do Next
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UCR 284: UTI PCR Under Fire – OIG Scrutiny, Denials, and What to Do Next
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概要
April 10, 2026
In this episode, Scott and Mark Painter break down the rapidly evolving and increasingly uncertain landscape surrounding UTI PCR testing, following heightened scrutiny from the OIG and a surge in payer denials—particularly for CPT code 87798. They discuss confusion around MUE limits, shifting interpretations from MACs, and the growing use of N35 denials triggering documentation requests. The episode outlines how practices should respond, including when to appeal, how to support medical necessity, and the risks of prematurely changing billing behavior without clear guidance. The key takeaway: stay disciplined, document thoroughly, and play the long game as policies continue to evolve.
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