`0516U`

What 0516U 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 0516U 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 0516U? These codes are bundled into it

0516U is a Column 1 code in 22 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
`0141U`		1 - modifier may bypass	Check pair
`0142U`		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
`84311`	Spectrophotometry	1 - modifier may bypass	Check pair
`88271`	Cytogenetics dna probe	1 - modifier may bypass	Check pair
`88272`	Cytogenetics 3-5	1 - modifier may bypass	Check pair
`88273`	Cytogenetics 10-30	1 - modifier may bypass	Check pair
`88274`	Cytogenetics 25-99	1 - modifier may bypass	Check pair
`88275`	Cytogenetics 100-300	1 - modifier may bypass	Check pair
`88291`	Cyto/molecular report	1 - modifier may bypass	Check pair
`88365`	Insitu hybridization (fish)	1 - modifier may bypass	Check pair
`88366`	Insitu hybridization (fish)	1 - modifier may bypass	Check pair
`88367`	Insitu hybridization auto	1 - modifier may bypass	Check pair
`88374`	M/phmtrc alys ishquant/semiq	1 - modifier may bypass	Check pair
`88377`	M/phmtrc alys ishquant/semiq	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
`G0463`	Hospital outpt clinic visit	1 - modifier may bypass	Check pair

0516U is bundled into these codes

0516U appears as a Column 2 code in 9 active edits. Reported with one of these Column 1 codes on the same date of service, 0516U is the code that denies.

Column 1 code	Short description	Modifier indicator
`0019U`		1	Check pair
`0022U`		1	Check pair
`0070U`		0	Check pair
`0347U`		0	Check pair
`0348U`		0	Check pair
`0349U`		0	Check pair
`0350U`		0	Check pair
`0392U`		0	Check pair
`81418`	Rx metab gen seq alys pnl 6	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.