DME Coding System (DMECS) Info
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.
- HCPCS Information:
- All Level II HCPCS codes beginning with the letters A, B, E, G, J, K, L, Q, and V are listed; however, not all are valid for submission to a DME MAC for processing.
- The tracking of coding and crosswalk history may be incomplete for codes invalid for DME MAC submission.
- New HCPCS are added annually when they are released by CMS and any updates are applied quarterly.
- See additional information below regarding Billable vs. Payable HCPCS codes.
- Modifiers: The PDAC can only provide the definitions of the modifiers as listed on DMECS. If assistance is needed regarding which modifier to use on claim submissions, please contact your DME MAC.
- Fee Schedules
- If a code does not have an established Fee Schedule, first check DMECS to make sure it is a valid code, and then call your DME MAC for billing and/or coverage information.
- DMEPOS Product Classification List (PCL)
- Coding verification by the PDAC is a voluntary process unless otherwise mandated by DME MAC policy.
- Only products that have been submitted to the PDAC/SADMERC for coding verification are posted to the PCL.
- Product information can be searched by manufacturer/distributor, product name, product/model number or HCPCS code
- If a product is not listed in the PCL, please email the PDAC Contact Center at firstname.lastname@example.org for coding assistance.
- It is the responsibility of the manufacturer to verify that their DMEPOS product information is listed accurately on the PCL and that education on the assigned code is provided to their distributors and/or suppliers. If any product information is inaccurate on the coding verification letter or on the PCL, the manufacturer should notify the PDAC immediately.
- Manufacturers/Distributors are responsible to notify the PDAC of any changes involving their products posted on the PCL. Click on the Request Updates to DMECS link for instructions on requesting updates to the PCL.
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.