. (LCD) for Urinalysis Policy (L12728) Contractor Information Contractor Name Noridian Administrative Services, LLC Contractor Number 00320 Contractor . TUBERCULOSIS OF OTHER FEMALE GENITAL ORGANS TUBERCLE BACILLI FOUND (IN SPUTUM) BY . SPUTUM) BY MICROSCOPY BUT FOUND BY BACTERIAL CULTURE 016.75 TUBERCULOSIS OF OTHER FEMALE GENITAL ORGANS TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED HISTOLOGICALLY 016.76 TUBERCULOSIS OF OTHER FEMALE GENITAL .

tuberculosis of kidney tubercle bacilli not found by bacteriological examination but tuberculosis confirmed histologically 016.06 . examination but tuberculosis confirmed histologically 016.36 . tuberculosis of other female genital organs tubercle bacilli not found (in sputum) by microscopy but found by bacterial culture 016.75

tuberculosis of peripheral lymph nodes tubercle bacilli not found by bacteriological examination but tuberculosis confirmed histologically 017.26 tuberculosis of peripheral lymph nodes tubercle bacilli not found by bacteriological or histological examination but tuberculosis confirmed by other methods (inoculation of . tuberculosis of other specified organs tubercle bacilli not found by bacteriological examination but tuberculosis confirmed histologically

Tuberculosis of other female genital organs, tubercle bacilli not found (in sputum) by microscopy, . Tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically; Tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological or histological examination, .

5 tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 6 tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods [inoculation of animals] . 016.7 Other female genital organs [0-6] Tuberculous: cervicitis. endometritis. 016.9 Genitourinary tuberculosis, unspecified

Tuberculosis of other female genital organs, tubercle bacilli found (in sputum) by microscopy; Tuberculosis of other female genital organs, tubercle . culture; Tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically; Tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological or . tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed .

. tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals) 014.80: . tubercle bacilli not found by bacteriological examination, . tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods .

5 tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically 6 tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods [inoculation of animals] . 016.7 Other female genital organs Tuberculous: cervicitis endometritis 016.9 Genitourinary tuberculosis, unspecified

Local Coverage Determination (LCD): Diagnostic Pap Tests (L31080) Contractor Name Wisconsin Physicians Service Insurance Corporation Document Information LCD ID . TUBERCULOSIS OF OTHER FEMALE GENITAL ORGANS TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS) 042 HUMAN IMMUNODEFICIENCY VIRUS (HIV) .