Ther rx mntr 200+ rx/sbsts — 116 bundling rules
If your bill lists 0520U alongside any of these codes as separate charges, it may be an unbundling error.
About the analyst
David Park researches procedure pricing and insurance reimbursement patterns at BillRazor Research. He specializes in cost comparison across care settings and metropolitan areas. Expertise: procedure pricing, insurance reimbursement, cost comparison.
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 0520U
116 code pairs that have billing restrictions with this procedure.
| Code | Description | Rule |
|---|---|---|
| 0110U | Rx mntr 1+oral onc rx&sbsts | May bill with modifier |
| 0251U | Hepcidin-25 elisa serum/plsm | May bill with modifier |
| 0517U | Ther rx mntr 80+ psyactiv rx | May bill with modifier |
| 0518U | Ther rx mntr 90+ pn&mtl hlth | Never bill together |
| 0519U | Ther rx mntr meds p/d/a 110+ | May bill with modifier |
| 80150 | Assay of amikacin | May bill with modifier |
| 80155 | Drug assay caffeine | May bill with modifier |
| 80156 | Assay carbamazepine total | May bill with modifier |
| 80157 | Assay carbamazepine free | May bill with modifier |
| 80158 | Drug assay cyclosporine | May bill with modifier |
| 80159 | Drug assay clozapine | May bill with modifier |
| 80162 | Assay of digoxin total | May bill with modifier |
| 80163 | Assay of digoxin free | May bill with modifier |
| 80164 | Assay dipropylacetic acd tot | May bill with modifier |
| 80165 | Dipropylacetic acid free | May bill with modifier |
| 80168 | Assay of ethosuximide | May bill with modifier |
| 80169 | Drug assay everolimus | May bill with modifier |
| 80170 | Assay of gentamicin | May bill with modifier |
| 80171 | Drug screen quant gabapentin | May bill with modifier |
| 80173 | Assay of haloperidol | May bill with modifier |
| 80175 | Drug screen quan lamotrigine | May bill with modifier |
| 80176 | Assay of lidocaine | May bill with modifier |
| 80177 | Drug scrn quan levetiracetam | May bill with modifier |
| 80178 | Assay of lithium | May bill with modifier |
| 80180 | Drug scrn quan mycophenolate | May bill with modifier |
| 80183 | Drug scrn quant oxcarbazepin | May bill with modifier |
| 80184 | Assay of phenobarbital | May bill with modifier |
| 80185 | Assay of phenytoin total | May bill with modifier |
| 80186 | Assay of phenytoin free | May bill with modifier |
| 80188 | Assay of primidone | May bill with modifier |
| 80190 | Assay of procainamide | May bill with modifier |
| 80192 | Assay of procainamide | May bill with modifier |
| 80194 | Assay of quinidine | May bill with modifier |
| 80195 | Assay of sirolimus | May bill with modifier |
| 80197 | Assay of tacrolimus | May bill with modifier |
| 80198 | Assay of theophylline | May bill with modifier |
| 80199 | Drug screen quant tiagabine | May bill with modifier |
| 80200 | Assay of tobramycin | May bill with modifier |
| 80201 | Assay of topiramate | May bill with modifier |
| 80202 | Assay of vancomycin | May bill with modifier |
| 80203 | Drug screen quant zonisamide | May bill with modifier |
| 80220 | Drug asy hydroxychloroquine | May bill with modifier |
| 80305 | Drug test prsmv dir opt obs | May bill with modifier |
| 80306 | Drug test prsmv instrmnt | May bill with modifier |
| 80320 | Drug screen quantalcohols | May bill with modifier |
| 80321 | Alcohols biomarkers 1or 2 | May bill with modifier |
| 80322 | Alcohols biomarkers 3/more | May bill with modifier |
| 80323 | Alkaloids nos | May bill with modifier |
| 80324 | Drug screen amphetamines 1/2 | May bill with modifier |
| 80325 | Amphetamines 3or 4 | May bill with modifier |
Showing 50 of 116 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.