(Poster 09) Cost of Universal Urinary Screening for Patients at Low Risk for Microhematuria

Objectives: There are currently no established guidelines for universal urinary screening for microhematuria (MH). At present, our urogynecology outpatient practice screens all new patients with a catheterized urine dipstick (Udip). The aim of our study was to evaluate the cost of universal screening in asymptomatic patients considered low-risk for MH by the 2025 American Urological Association (AUA) guidelines.

Methods: This retrospective chart review assessed 30 new patients considered low-risk as per the AUA 2025 MH guidelines. All patients had undergone catheterized Udip during initial office visit. For our indicated population, we selectively sampled for patients with symptoms of urinary tract infection (UTI) or lower urinary tract symptoms (LUTS). For our non-indicated population, we selected for patients who were asymptomatic for UTI symptoms or LUTS. We excluded patients with gross hematuria or history of genitourinary malignancy. Costs were established based on the average of the included patient billings and 2024 Medicare allowable reimbursement rates using CPT codes 81003, 52000, 76770, and 74177. Comparative cost scenarios were modeled for indicated vs. non-indicated/ screening Udip and analyzed using paired T-test.

Results: Relevant patient demographics are displayed in Table 1. A total of 30 patients were sampled for our cohort: 15 patients with indicated Udip and 15 patients with non-indicated Udip. Total charges for the 15 patients who underwent indicated Udip were $15,425.63 compared to the 15 patients who underwent non-indicated Udip, at $10,576.23 (Figure 1; p=0.10). Patient fees for indicated Udip were $1,668.04 vs. $1,939.45 for non-indicated (p=0.33), while institutional collections were $14,753.22 vs. $17,416.53, respectively (p=0.16). Total charges for all 30 patients who underwent Udip with subsequent workup was $26,001.86. If we had only performed Udip in this cohort if patients had UTI symptoms or LUTS, the charges would have been $15,425.63. This represents a potential cost savings of $10,576.23. Moreover, there would have been a potential cost savings in patient fees of $642.19 while institutional collections would decrease by $3,719.71.

Conclusions: Performing a Udip only when indicated in a low-risk population, as compared to universal screening, has the potential cost savings of up to $10,576.23. Total charges, patient costs, and institutional collections were similar between those who underwent indicated vs. non-indicated Udip. While the financial benefit is clear, future studies assessing clinical outcomes of deferring universal screening should be performed.

Figure 1. Cost breakdown of screening vs. indicated Udip based patient billings and 2024 Medicare reimbursement rates.
Table 1. Patient demographics for indicated vs. non-indicated (screening) Udip. IQR = interquartile range. GU = genitourinary.