`0495U`

What 0495U 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 0495U 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 0495U? These codes are bundled into it

0495U is a Column 1 code in 26 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
`0011M`		0 - no modifier bypass	Check pair
`0021U`		0 - no modifier bypass	Check pair
`0113U`		0 - no modifier bypass	Check pair
`0359U`		0 - no modifier bypass	Check pair
`0433U`		0 - no modifier 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
`81313`	Pca3/klk3 antigen	1 - modifier may bypass	Check pair
`81539`	Oncology prostate prob score	0 - no modifier bypass	Check pair
`83516`	Immunoassay nonantibody	1 - modifier may bypass	Check pair
`83518`	Immunoassay dipstick	1 - modifier may bypass	Check pair
`83519`	Ria nonantibody	1 - modifier may bypass	Check pair
`83520`	Immunoassay quant nos nonab	1 - modifier may bypass	Check pair
`86294`	Immunoassay tumor qual	1 - modifier may bypass	Check pair
`86316`	Immunoassay tumor other	1 - modifier may bypass	Check pair
`88182`	Cell marker study	1 - modifier may bypass	Check pair
`88184`	Flowcytometry/ tc 1 marker	1 - modifier may bypass	Check pair
`88187`	Flowcytometry/read 2-8	1 - modifier may bypass	Check pair
`88188`	Flowcytometry/read 9-15	1 - modifier may bypass	Check pair
`88189`	Flowcytometry/read 16 & >	1 - modifier may bypass	Check pair
`96523`	Irrig drug delivery device	0 - no modifier bypass	Check pair
`G0102`	Prostate ca screening; dre	1 - modifier may bypass	Check pair
`G0103`	Psa screening	1 - modifier may bypass	Check pair

0495U is bundled into these codes

0495U appears as a Column 2 code in 7 active edits. Reported with one of these Column 1 codes on the same date of service, 0495U is the code that denies.

Column 1 code	Short description	Modifier indicator
`0005U`		1	Check pair
`0475U`		1	Check pair
`0523U`		1	Check pair
`0530U`		1	Check pair
`81541`	Onc prostate mrna 46 genes	0	Check pair
`81542`	Onc prostate mrna 22 cnt gen	0	Check pair
`81551`	Onc prostate 3 genes	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.