0472U
What 0472U 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 0472U 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 0472U? These codes are bundled into it
0472U is a Column 1 code in 11 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 | |
|---|---|---|---|
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 |
83520 | Immunoassay quant nos nonab | 1 - modifier may bypass | Check pair |
86038 | Antinuclear antibodies | 1 - modifier may bypass | Check pair |
86235 | Nuclear antigen antibody | 1 - modifier may bypass | Check pair |
86431 | Rheumatoid factor quant | 1 - modifier may bypass | Check pair |
96523 | Irrig drug delivery device | 0 - no modifier bypass | Check pair |
G0452 | Molecular pathology interpr | 1 - modifier may bypass | Check pair |
0472U is bundled into these codes
0472U appears as a Column 2 code in 1 active edits. Reported with one of these Column 1 codes on the same date of service, 0472U is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
0522U | 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.