Urinalysis, Automated (CPT 81003)
Medicare Rate vs. Lab Charges
Medicare pays $2.92 for this test. Labs commonly charge $15.00–$67.00. That's a 414%–2195% markup above what Medicare pays.
What This Test Is
An automated urinalysis checks for glucose, protein, nitrites, leukocyte esterase, and other markers in urine. It's used to screen for urinary tract infections, kidney disease, and diabetes. It's one of the cheapest lab tests but often has the highest markup.
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $2.92 |
| Typical Lab Charge Range | $15.00–$67.00 |
| Average Markup Above Medicare | 414%–2195% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers urinalysis when medically necessary—routine screening during annual physicals, or when evaluating UTI symptoms, kidney disease, or diabetes.
Common Reasons for Denial
- Screening test in asymptomatic patient without clinical indication
- Routine urinalysis at annual physical may require specific diagnosis codes
- Duplicate test—recent urinalysis on file
- Ordered without documentation of clinical reason
- Patient with no history of kidney disease or UTI getting tested without symptoms
What To Do If You're Overcharged
If you received a lab bill that seems unusually high compared to Medicare rates:
- Check your Explanation of Benefits (EOB) from Medicare or your insurance to see what should have been paid.
- Request an itemized bill from the lab showing all charges.
- Compare to GougeStop rates for your area to see if the charge is reasonable.
- Contact the lab's billing department to dispute erroneous charges or negotiate a lower rate.
- File an appeal with Medicare if a claim was incorrectly denied.
Frequently Asked Questions
A: Because the base cost is so low ($2.92 Medicare rate) but lab charges are fixed ($15–$67 per test). The markup percentage is huge, but absolute cost is still low.
A: Automated urinalysis runs samples through a machine for basic screening. Microscopic adds manual examination of cells. Microscopic costs more but provides more detail.
A: Annual screening during physical is standard. If you have symptoms or a UTI history, your doctor may order it more frequently.