Onc bldr dna ngs 60gen&aneup — 96 bundling rules
If your bill lists 0467U alongside any of these codes as separate charges, it may be an unbundling error.
About the analyst
Kevin Nyk analyzes hospital pricing data at BillRazor Research. He specializes in Medicare reimbursement patterns and chargemaster pricing across U.S. hospitals. Expertise: hospital pricing, Medicare rates, chargemaster analysis.
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 0467U
96 code pairs that have billing restrictions with this procedure.
| Code | Description | Rule |
|---|---|---|
| 0012M | Onc mrna 5 gen rsk urthl ca | May bill with modifier |
| 0013M | Onc mrna 5 gen recr urthl ca | May bill with modifier |
| 0169U | Nudt15&tpmt gene com vrnt | May bill with modifier |
| 0235U | Pten full gene analysis | May bill with modifier |
| 0286U | Cep72 nudt15&tpmt gene alys | May bill with modifier |
| 0365U | Onc bldr 10 ur hrbr urthl ca | Never bill together |
| 0452U | Onc bldr mthyl penk lte-qmsp | Never bill together |
| 0523U | Onc soltum dna ngs snv 22gen | May bill with modifier |
| 81170 | Abl1 gene | May bill with modifier |
| 81191 | Ntrk1 translocation analysis | May bill with modifier |
| 81192 | Ntrk2 translocation analysis | May bill with modifier |
| 81193 | Ntrk3 translocation analysis | May bill with modifier |
| 81194 | Ntrk translocation analysis | May bill with modifier |
| 81212 | Brca1&2 185&5385&6174 vrnt | May bill with modifier |
| 81215 | Brca1 gene known famil vrnt | May bill with modifier |
| 81216 | Brca2 gene full seq alys | May bill with modifier |
| 81217 | Brca2 gene known famil vrnt | May bill with modifier |
| 81235 | Egfr gene com variants | May bill with modifier |
| 81245 | Flt3 gene | May bill with modifier |
| 81246 | Flt3 gene analysis | May bill with modifier |
| 81261 | Igh gene rearrange amp meth | May bill with modifier |
| 81262 | Igh gene rearrang dir probe | May bill with modifier |
| 81263 | Igh vari regional mutation | May bill with modifier |
| 81264 | Igk rearrangeabn clonal pop | May bill with modifier |
| 81272 | Kit gene targeted seq analys | May bill with modifier |
| 81273 | Kit gene analys d816 variant | May bill with modifier |
| 81275 | Kras gene variants exon 2 | May bill with modifier |
| 81276 | Kras gene addl variants | May bill with modifier |
| 81278 | Igh@/bcl2 translocation alys | May bill with modifier |
| 81279 | Jak2 gene trgt sequence alys | May bill with modifier |
| 81283 | Ifnl3 gene | May bill with modifier |
| 81288 | Mlh1 gene | May bill with modifier |
| 81290 | Mcoln1 gene | May bill with modifier |
| 81291 | Mthfr gene | May bill with modifier |
| 81292 | Mlh1 gene full seq | May bill with modifier |
| 81293 | Mlh1 gene known variants | May bill with modifier |
| 81294 | Mlh1 gene dup/delete variant | May bill with modifier |
| 81295 | Msh2 gene full seq | May bill with modifier |
| 81296 | Msh2 gene known variants | May bill with modifier |
| 81297 | Msh2 gene dup/delete variant | May bill with modifier |
| 81298 | Msh6 gene full seq | May bill with modifier |
| 81299 | Msh6 gene known variants | May bill with modifier |
| 81300 | Msh6 gene dup/delete variant | May bill with modifier |
| 81301 | Microsatellite instability | May bill with modifier |
| 81307 | Palb2 gene full gene seq | May bill with modifier |
| 81308 | Palb2 gene known famil vrnt | May bill with modifier |
| 81309 | Pik3ca gene trgt seq alys | May bill with modifier |
| 81310 | Npm1 gene | May bill with modifier |
| 81311 | Nras gene variants exon 2&3 | May bill with modifier |
| 81314 | Pdgfra gene | May bill with modifier |
Showing 50 of 96 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.