0528U
What 0528U 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 0528U at 1 unit 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: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with 0528U? These codes are bundled into it
0528U is a Column 1 code in 49 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 | |
|---|---|---|---|
0010U | 1 - modifier may bypass | Check pair | |
0115U | 0 - no modifier bypass | Check pair | |
0202U | 1 - modifier may bypass | Check pair | |
0223U | 1 - modifier may bypass | Check pair | |
0225U | 0 - no modifier bypass | Check pair | |
0408U | 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 |
81400 | Mopath procedure level 1 | 1 - modifier may bypass | Check pair |
81401 | Mopath procedure level 2 | 1 - modifier may bypass | Check pair |
81402 | Mopath procedure level 3 | 1 - modifier may bypass | Check pair |
81403 | Mopath procedure level 4 | 1 - modifier may bypass | Check pair |
81404 | Mopath procedure level 5 | 1 - modifier may bypass | Check pair |
81405 | Mopath procedure level 6 | 1 - modifier may bypass | Check pair |
81406 | Mopath procedure level 7 | 1 - modifier may bypass | Check pair |
87260 | Adenovirus ag if | 1 - modifier may bypass | Check pair |
87275 | Influenza b ag if | 1 - modifier may bypass | Check pair |
87276 | Influenza a ag if | 1 - modifier may bypass | Check pair |
87278 | Legion pneumophilia ag if | 0 - no modifier bypass | Check pair |
87279 | Parainfluenza ag if | 1 - modifier may bypass | Check pair |
87280 | Respiratory syncytial ag if | 1 - modifier may bypass | Check pair |
87301 | Adenovirus ag ia | 1 - modifier may bypass | Check pair |
87400 | Influenza a/b each ag ia | 1 - modifier may bypass | Check pair |
87420 | Resp syncytial virus ag ia | 1 - modifier may bypass | Check pair |
87428 | Sarscov & inf vir a&b ag ia | 1 - modifier may bypass | Check pair |
87486 | Chlmyd pneum dna amp probe | 0 - no modifier bypass | Check pair |
87501 | Influenza dna amp prob 1+ | 1 - modifier may bypass | Check pair |
Showing 30 of 49 column 2 codes. Use the pair checker for any specific combination.
0528U is bundled into these codes
0528U appears as a Column 2 code in 2 active edits. Reported with one of these Column 1 codes on the same date of service, 0528U is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
81407 | Mopath procedure level 8 | 1 | Check pair |
81408 | Mopath procedure level 9 | 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.