0469U
What 0469U 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 0469U at 2 units per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Clinical: CMS Workgroup. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with 0469U? These codes are bundled into it
0469U is a Column 1 code in 176 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 | |
|---|---|---|---|
0209U | 1 - modifier may bypass | Check pair | |
0230U | 1 - modifier may bypass | Check pair | |
0231U | 1 - modifier may bypass | Check pair | |
0232U | 1 - modifier may bypass | Check pair | |
0233U | 1 - modifier may bypass | Check pair | |
0234U | 1 - modifier may bypass | Check pair | |
0235U | 1 - modifier may bypass | Check pair | |
0236U | 1 - modifier may bypass | Check pair | |
0238U | 1 - modifier may bypass | Check pair | |
0252U | 1 - modifier may bypass | Check pair | |
0327U | 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 |
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 |
Showing 30 of 176 column 2 codes. Use the pair checker for any specific combination.
0469U is bundled into these codes
0469U appears as a Column 2 code in 36 active edits. Reported with one of these Column 1 codes on the same date of service, 0469U is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
0022U | 1 | Check pair | |
0036U | 1 | Check pair | |
0037U | 1 | Check pair | |
0050U | 1 | Check pair | |
0079U | 1 | Check pair | |
0129U | 1 | Check pair | |
0212U | 0 | Check pair | |
0213U | 0 | Check pair | |
0260U | 1 | Check pair | |
0264U | 1 | Check pair | |
0265U | 1 | Check pair | |
0266U | 1 | Check pair | |
0267U | 1 | Check pair | |
0318U | 0 | Check pair | |
0335U | 0 | 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.