`0004M`

What 0004M is

This code appears in the Medicare NCCI edit tables. It has no RVUs in the CY2026 Physician Fee Schedule file.

Medically Unlikely Edit (MUE)

Medicare caps 0004M at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 0004M? These codes are bundled into it

0004M is a Column 1 code in 296 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 code	Modifier indicator
`0009U`	1 - modifier may bypass	Check pair
`0016U`	1 - modifier may bypass	Check pair
`0017U`	1 - modifier may bypass	Check pair
`0027U`	1 - modifier may bypass	Check pair
`0030U`	1 - modifier may bypass	Check pair
`0034U`	1 - modifier may bypass	Check pair
`0040U`	1 - modifier may bypass	Check pair
`0046U`	1 - modifier may bypass	Check pair
`0049U`	1 - modifier may bypass	Check pair
`0070U`	1 - modifier may bypass	Check pair
`0071U`	1 - modifier may bypass	Check pair
`0086U`	1 - modifier may bypass	Check pair
`0111U`	1 - modifier may bypass	Check pair
`0136U`	1 - modifier may bypass	Check pair
`0137U`	1 - modifier may bypass	Check pair
`0138U`	1 - modifier may bypass	Check pair
`0140U`	1 - modifier may bypass	Check pair
`0141U`	1 - modifier may bypass	Check pair
`0142U`	1 - modifier may bypass	Check pair
`0155U`	1 - modifier may bypass	Check pair
`0156U`	1 - modifier may bypass	Check pair
`0157U`	1 - modifier may bypass	Check pair
`0158U`	1 - modifier may bypass	Check pair
`0159U`	1 - modifier may bypass	Check pair
`0160U`	1 - modifier may bypass	Check pair
`0161U`	1 - modifier may bypass	Check pair
`0169U`	1 - modifier may bypass	Check pair
`0177U`	1 - modifier may bypass	Check pair
`0212U`	1 - modifier may bypass	Check pair
`0213U`	1 - modifier may bypass	Check pair

Showing 30 of 296 column 2 codes. Use the pair checker for any specific combination.

0004M is bundled into these codes

0004M appears as a Column 2 code in 3 active edits. Reported with one of these Column 1 codes on the same date of service, 0004M is the code that denies.

Column 1 code	Modifier indicator
`0411U`	1	Check pair
`0425U`	1	Check pair
`0500U`	1	Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.