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DME Coding System (DMECS) Info


Click here to Search DMECS for Codes and Fees

The Pricing, Data Analysis and Coding (PDAC) contractor maintains the Durable Medical Equipment Coding System (DMECS). This interactive tool can be used to search for the following information: (Refer to the DMECS Guide for instructions on searching DMECS.)

A two page DMECS At-A-Glance document has been created to briefly highlight the key features of DMECS. Please print this document for a quick reference.

DMECS is a coding guide for DMEPOS suppliers, manufacturers and distributors that provides HCPCS coding information applicable to claim submission to the DME MAC. DMECS is not a substitute for official CMS HCPCS releases which can be found on CMS’ website at http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html?redirect
=/MedHCPCSGenInfo/
. HCPCS codes are considered valid or invalid for submission to Medicare based either on the Centers for Medicare and Medicaid Services’ (CMS) or DME MAC instructions. Although a HCPCS code may appear as valid for submission to Medicare on the official HCPCS release, that same HCPCS code may appear on DMECS as invalid for submission to the DME MAC (or previous DMERC) based on criteria found in the Local Coverage Determination (LCD). DMECS will refer to the LCD with additional information that pertains to claim submission.

DMECS is available 24 hours a day, 7 days a week except when maintenance is being conducted.

Billable HCPCS Codes vs. Payable HCPCS Codes
The PDAC receives frequent inquiries regarding a billable HCPCS code and a payable HCPCS code. One may think the two are the same; however this is not the case.

A billable HCPCS code is one that is submitted on a claim to the DME MAC. A billable HCPCS code will display as active on DMECS (no end date). If the HCPCS code is billable to the DME MAC it does not necessarily mean it is payable.

A payable HCPCS code is one that will be considered for payment by the DME MACs if the item meets the definition of DME, falls under a benefit category, and is covered under other general DME guidelines. Specific details can be found on the applicable DME MAC web site for which you are billing.

When inquiring about a HCPCS code to determine if the code is billable or payable to a DME MAC, first check the National Coverage Determination (NCD), the Local Coverage Determination (LCD), and the DME MAC web site to determine whether the code is billable and/or payable.

Example: HCPCS code A5510 is currently listed on DMECS as a billable code to the DME MAC. The current LCD states: “Items represented by code A5510 reflect compression molding to the patient's foot over time through the heat and pressure generated by wearing a shoe with the insert present. Since these inserts are not considered total contact at the time of dispensing, they do not meet the requirements of the benefit category and will be denied as non-covered”. The LCD indicates that this HCPCS code is billable but not payable by the DME MACs.