0216U
What 0216U 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 0216U 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 0216U? These codes are bundled into it
0216U is a Column 1 code in 19 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 | Short description | Modifier indicator | |
|---|---|---|---|
0233U | 0 - no modifier bypass | Check pair | |
80503 | Path clin consltj sf 5-20 | 1 - modifier may bypass | Check pair |
80504 | Path clin consltj mod 21-40 | 1 - modifier may bypass | Check pair |
80505 | Path clin consltj high 41-60 | 1 - modifier may bypass | Check pair |
80506 | Path clin consltj prolng svc | 1 - modifier may bypass | Check pair |
81178 | Atxn1 gene detc abnor allele | 0 - no modifier bypass | Check pair |
81179 | Atxn2 gene detc abnor allele | 0 - no modifier bypass | Check pair |
81180 | Atxn3 gene detc abnor allele | 0 - no modifier bypass | Check pair |
81181 | Atxn7 gene detc abnor allele | 0 - no modifier bypass | Check pair |
81182 | Atxn8os gen detc abnor allel | 0 - no modifier bypass | Check pair |
81183 | Atxn10 gene detc abnor allel | 0 - no modifier bypass | Check pair |
81284 | Fxn gene detc abnor alleles | 0 - no modifier bypass | Check pair |
81285 | Fxn gene charac alleles | 0 - no modifier bypass | Check pair |
81286 | Fxn gene full gene sequence | 0 - no modifier bypass | Check pair |
81289 | Fxn gene known famil variant | 0 - no modifier bypass | Check pair |
81343 | Ppp2r2b gen detc abnor allel | 0 - no modifier bypass | Check pair |
81344 | Tbp gene detc abnor alleles | 0 - no modifier bypass | Check pair |
81460 | Whole mitochondrial genome | 0 - no modifier bypass | Check pair |
88248 | Chromosome analysis 50-100 | 0 - no modifier bypass | 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.