Urine Reflex to C&S Updates (Nursing Homes)

Nursing Home Memo
Re: UA Reflex to C&S (ID & Sensitivity) If Indicated

Medicare regulations prohibit laboratories from automatically ordering additional laboratory tests based on results from prior tests. However, “Reflex” testing may be done if the client specifies this in the original order.

When a client orders “Urinalysis w/Reflex to Culture and Sensitivity (C&S)”,
DOCTORS LAB will reflexively order a urine culture if one or more of the following conditions are met:

  • Clarity: Cloudy, turbid
  • Nitrite: Positive reaction on the dipstick
  • Leukocyte Esterase: Positive reaction on the dipstick
  • Catalase: Positive


  • In the case of the a suspected UTI, we recommend ordering the “Urinalysis w/Reflex to C&S”
  • If a doctor wants a C&S ‘no matter what” and orders one, it will be performed
  • If a UA is ordered without a C&S order or Reflex to a C&S, regardless of the UA results, a C&S will not be performed

Rev 2.0 01.10.20