`0497U`

What 0497U 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 0497U 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 0497U? These codes are bundled into it

0497U is a Column 1 code in 56 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
`0005U`		0 - no modifier bypass	Check pair
`0011M`		0 - no modifier bypass	Check pair
`0021U`		0 - no modifier bypass	Check pair
`0047U`		0 - no modifier bypass	Check pair
`0113U`		1 - modifier may bypass	Check pair
`0169U`		1 - modifier may bypass	Check pair
`0228U`		0 - no modifier bypass	Check pair
`0239U`		1 - modifier may bypass	Check pair
`0244U`		1 - modifier may bypass	Check pair
`0286U`		1 - modifier may bypass	Check pair
`0339U`		0 - no modifier bypass	Check pair
`0340U`		1 - modifier may bypass	Check pair
`0343U`		0 - no modifier bypass	Check pair
`0359U`		0 - no modifier bypass	Check pair
`0403U`		0 - no modifier bypass	Check pair
`0433U`		0 - no modifier bypass	Check pair
`0475U`		0 - no modifier bypass	Check pair
`0523U`		1 - modifier may bypass	Check pair
`0530U`		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
`81228`	Cytog alys chrml abnr cgh	1 - modifier may bypass	Check pair
`81229`	Cytog alys chrml abnr snpcgh	1 - modifier may bypass	Check pair
`81283`	Ifnl3 gene	1 - modifier may bypass	Check pair
`81313`	Pca3/klk3 antigen	1 - modifier may bypass	Check pair
`81400`	Mopath procedure level 1	1 - modifier may bypass	Check pair
`81401`	Mopath procedure level 2	1 - modifier may bypass	Check pair

Showing 30 of 56 column 2 codes. Use the pair checker for any specific combination.

0497U is bundled into these codes

0497U appears as a Column 2 code in 4 active edits. Reported with one of these Column 1 codes on the same date of service, 0497U is the code that denies.

Column 1 code	Short description	Modifier indicator
`0242U`		1	Check pair
`81415`	Exome sequence analysis	1	Check pair
`81425`	Genome sequence analysis	1	Check pair
`81541`	Onc prostate mrna 46 genes	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.