The PDAC maintains a list of which DMEPOS items are subject to mandatory code verification Code verification is mandatory for some products, but not mandatory for other products. The PDAC does not have the authority to create a HCPCS code nor amend an existing HCPCS code description. The PDAC can only verify that a product meets the definition of an existing HCPCS code. The PDAC can be accessed through This website lists all products that have been code verified. With the above in mind, we will now address how a manufacturer can (i) obtain verification that a product fits within an existing HCPCS code or (ii) can apply for a new HCPCS code.Ĭode verification is handled by the PDAC, a Medicare contractor. CMS’ recent DMEPOS proposed rule proposes to codify many of the longstanding Level II HCPCS code application processes, including evaluation criteria, re-application issues and other processes. ![]() If there is no existing HCPCS code that describes the product, the manufacturer (or another entity) can apply for a new or revised HCPCS code through CMS’ Level II HCPCS code process. If option (ii) is used, the DME MACs that process the claims will individually review the claim and determine whether Medicare will cover and pay for the item this is time consuming and unpredictable. In order for Medicare to cover and pay for an item of DME (“product”), (i) the product must fit within an established Medicare billing code known as a HCPCS code, or (ii) the product may be billed using the miscellaneous DME HCPCS code (E1399). ![]() If it will be difficult for the DME supplier to sell or rent the product to Medicare patients, then the supplier will not be inclined to purchase the product from the manufacturer. If neither of these events happen, then it will be difficult for the DME supplier to sell/rent the product to Medicare patients because (i) Medicare will likely not pay for the product…meaning that (ii) the Medicare patient will have to pay for the product out-of-pocket. If a manufacturer desires to sell a product to DME suppliers that will, in turn, sell or rent the product to Medicare patients, then the manufacturer will want the item to either (i) fit within an established HCPCS code or (ii) be awarded a new HCPCS code. This article explains the different roles and responsibilities of each of these processes, and how they relate to each other. AMARILLO, TX – There is often confusion between the Centers for Medicare and Medicaid Services’ (“CMS”) national HCPCS coding process and the Pricing, Data Analysis and Coding (“PDAC”) code verification process.
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