0867T Tpla b9 prst8 hyprplsa>=50ml

What 0867T is

CMS fee schedule short descriptor: Tpla b9 prst8 hyprplsa>=50ml.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 0867T (CY2026)

This code has no Physician Fee Schedule rate: Carrier-priced - the Medicare contractor sets the price. It may be paid under a different fee schedule (clinical laboratory, DMEPOS, anesthesia) or not paid at all - check the relevant CMS schedule.

Medically Unlikely Edit (MUE)

Medicare caps 0867T at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Anatomic Consideration. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 0867T? These codes are bundled into it

0867T is a Column 1 code in 236 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.

Showing 30 of 236 column 2 codes. Use the pair checker for any specific combination.

0867T is bundled into these codes

0867T appears as a Column 2 code in 21 active edits. Reported with one of these Column 1 codes on the same date of service, 0867T is the code that denies.

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.