`0431U`

What 0431U 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 0431U 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 0431U? These codes are bundled into it

0431U is a Column 1 code in 365 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
`0070U`		1 - modifier may bypass	Check pair
`36591`	Draw blood off venous device	0 - no modifier bypass	Check pair
`36592`	Collect blood from picc	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
`81105`	Hpa-1 genotyping	1 - modifier may bypass	Check pair
`81106`	Hpa-2 genotyping	1 - modifier may bypass	Check pair
`81107`	Hpa-3 genotyping	1 - modifier may bypass	Check pair
`81108`	Hpa-4 genotyping	1 - modifier may bypass	Check pair
`81109`	Hpa-5 genotyping	1 - modifier may bypass	Check pair
`81110`	Hpa-6 genotyping	1 - modifier may bypass	Check pair
`81111`	Hpa-9 genotyping	1 - modifier may bypass	Check pair
`81112`	Hpa-15 genotyping	1 - modifier may bypass	Check pair
`81120`	Idh1 common variants	1 - modifier may bypass	Check pair
`81121`	Idh2 common variants	1 - modifier may bypass	Check pair
`81161`	Dmd dup/delet analysis	1 - modifier may bypass	Check pair
`81163`	Brca1&2 gene full seq alys	1 - modifier may bypass	Check pair
`81164`	Brca1&2 gen ful dup/del alys	1 - modifier may bypass	Check pair
`81165`	Brca1 gene full seq alys	1 - modifier may bypass	Check pair
`81166`	Brca1 gene full dup/del alys	1 - modifier may bypass	Check pair
`81167`	Brca2 gene full dup/del alys	1 - modifier may bypass	Check pair
`81168`	Ccnd1/igh translocation alys	1 - modifier may bypass	Check pair
`81170`	Abl1 gene	1 - modifier may bypass	Check pair
`81171`	Aff2 gen aly detc abnl allel	1 - modifier may bypass	Check pair
`81172`	Aff2 gen alys charac alleles	1 - modifier may bypass	Check pair
`81173`	Ar gene full gene sequence	1 - modifier may bypass	Check pair
`81174`	Ar gene known famil variant	1 - modifier may bypass	Check pair
`81175`	Asxl1 full gene sequence	1 - modifier may bypass	Check pair
`81176`	Asxl1 gene target seq alys	1 - modifier may bypass	Check pair

Showing 30 of 365 column 2 codes. Use the pair checker for any specific combination.

0431U is bundled into these codes

0431U appears as a Column 2 code in 12 active edits. Reported with one of these Column 1 codes on the same date of service, 0431U is the code that denies.

Column 1 code	Short description	Modifier indicator
`81162`	Brca1&2 gen full seq dup/del	1	Check pair
`81408`	Mopath procedure level 9	1	Check pair
`81411`	Aortic dysfunction/dilation	1	Check pair
`81412`	Ashkenazi jewish assoc dis	1	Check pair
`81415`	Exome sequence analysis	1	Check pair
`81425`	Genome sequence analysis	1	Check pair
`81427`	Genome re-evaluation	1	Check pair
`81430`	Hearing loss sequence analys	1	Check pair
`81440`	Mitochondrial gene	1	Check pair
`81442`	Noonan spectrum disorders	1	Check pair
`81443`	Genetic tstg severe inh cond	1	Check pair
`81455`	So/hl 51/>gsap dna/dna&rna	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.