Rx test prsmv ur w/def conf — 119 bundling rules
If your bill lists 0007U alongside any of these codes as separate charges, it may be an unbundling error.
About the analyst
Michael Glenn reviews CMS datasets and drug pricing at BillRazor Research. He focuses on NADAC acquisition costs and procedure coding accuracy. Expertise: drug pricing, NADAC data, CPT coding.
Common unbundling errors — medical procedures
Unbundling occurs when medical providers bill two separate codes for services that should be combined into a single charge according to National Correct Coding Initiative (NCCI) rules. In other procedures including anesthesia, radiology, pathology, and miscellaneous support services, common unbundling patterns include separately billing diagnostic imaging with its professional interpretation when both should be included in one comprehensive code, and charging for basic monitoring or preparation services alongside the primary procedure when these components are considered integral parts of the main service. Another frequent error involves billing multiple pathology examination codes for what constitutes a single comprehensive analysis. With 809 other codes subject to bundling restrictions in the NCCI database, these errors create charges above the benchmark for patients who receive multiple bills for what should constitute one complete service. The potential difference between unbundled billing and correct coding practices can significantly impact patient financial responsibility, as they may face duplicate charges for components of care that medical coding standards define as a single billable service.
What to check on your bill
When reviewing itemized bills for procedure bundling issues, patients should examine several key areas to identify potential billing irregularities. Look for multiple procedure codes billed on the same date that represent components of a comprehensive service, such as separate charges for incision, repair, and closure when these steps are typically included in one primary procedure code. Watch for code patterns where related procedures share the same first three digits, as these often indicate services that should be bundled together under Medicare's Correct Coding Initiative. Check for appropriate modifier usage, particularly modifier 59 or XS, which legitimately allow separate billing when procedures are performed on different anatomical sites or during distinct sessions. Without proper modifiers, separately billed related procedures may represent charges above the benchmark. Compare your itemized statement against standard bundling practices for your specific procedure type to identify potential differences in billing patterns.
All bundling rules for 0007U
119 code pairs that have billing restrictions with this procedure.
| Code | Description | Rule |
|---|---|---|
| 0051U | Rx mntr lc-ms/ms ur/bld 31 | Never bill together |
| 0054U | Rx mntr 14+ drugs & sbsts | Never bill together |
| 0082U | Rx test def 90+ rx/sbsts ur | Never bill together |
| 0086U | Nfct ds bact&fng org id 6+ | May bill with modifier |
| 0093U | Rx mntr 65 com drugs urine | Never bill together |
| 0110U | Rx mntr 1+oral onc rx&sbsts | Never bill together |
| 0116U | Rx mntr nzm ia 35+oral flu | Never bill together |
| 0119U | Crd ceramides liq chrom plsm | May bill with modifier |
| 0140U | Nfct ds fungi dna 15 trgt | May bill with modifier |
| 0141U | Nfct ds bact&fng gram pos | May bill with modifier |
| 0142U | Nfct ds bact&fng gram neg | May bill with modifier |
| 0227U | Rx asy prsmv 30+rx/metablt | Never bill together |
| 0251U | Hepcidin-25 elisa serum/plsm | May bill with modifier |
| 0321U | Iadna gu pthgn 20bct&fng org | May bill with modifier |
| 0328U | Drug assay 120+ rx&metablt | May bill with modifier |
| 80305 | Drug test prsmv dir opt obs | Never bill together |
| 80306 | Drug test prsmv instrmnt | Never bill together |
| 80307 | Drug test prsmv chem anlyzr | Never bill together |
| 80320 | Drug screen quantalcohols | Never bill together |
| 80321 | Alcohols biomarkers 1or 2 | Never bill together |
| 80322 | Alcohols biomarkers 3/more | Never bill together |
| 80323 | Alkaloids nos | Never bill together |
| 80324 | Drug screen amphetamines 1/2 | Never bill together |
| 80325 | Amphetamines 3or 4 | Never bill together |
| 80326 | Amphetamines 5 or more | Never bill together |
| 80327 | Anabolic steroid 1 or 2 | Never bill together |
| 80328 | Anabolic steroid 3 or more | Never bill together |
| 80329 | Analgesics non-opioid 1 or 2 | Never bill together |
| 80330 | Analgesics non-opioid 3-5 | Never bill together |
| 80331 | Analgesics non-opioid 6/more | Never bill together |
| 80332 | Antidepressants class 1 or 2 | Never bill together |
| 80333 | Antidepressants class 3-5 | Never bill together |
| 80334 | Antidepressants class 6/more | Never bill together |
| 80335 | Antidepressant tricyclic 1/2 | Never bill together |
| 80336 | Antidepressant tricyclic 3-5 | Never bill together |
| 80337 | Tricyclic & cyclicals 6/more | Never bill together |
| 80338 | Antidepressant not specified | Never bill together |
| 80339 | Antiepileptics nos 1-3 | Never bill together |
| 80340 | Antiepileptics nos 4-6 | Never bill together |
| 80341 | Antiepileptics nos 7/more | Never bill together |
| 80342 | Antipsychotics nos 1-3 | Never bill together |
| 80343 | Antipsychotics nos 4-6 | Never bill together |
| 80344 | Antipsychotics nos 7/more | Never bill together |
| 80345 | Drug screening barbiturates | Never bill together |
| 80346 | Benzodiazepines1-12 | Never bill together |
| 80347 | Benzodiazepines 13 or more | Never bill together |
| 80348 | Drug screening buprenorphine | Never bill together |
| 80349 | Cannabinoids natural | Never bill together |
| 80350 | Cannabinoids synthetic 1-3 | Never bill together |
| 80351 | Cannabinoids synthetic 4-6 | Never bill together |
Showing 50 of 119 rules. Show all
FAQ — medical procedure bundling
What is NCCI bundling and what does 'bundled' mean on a medical bill?
How can I identify if codes were incorrectly unbundled on my bill?
What should I do if I find unbundled charges on my medical bill?
When is it legitimate to use modifiers to override NCCI bundling rules?
Data source: CMS National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits, updated quarterly. These code pairs are maintained by CMS to prevent improper billing of services that should be billed as a single procedure.
What this means: When two codes are listed as an NCCI edit pair, billing them separately on the same date of service is typically incorrect. "Never bill together" means no modifier can override the rule. "May bill with modifier" means the codes can be billed separately with appropriate documentation.