Discrepancies in Product Review Information
It is the responsibility of the Pricing, Data Analysis and Coding (PDAC) to review Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) products available for Medicare beneficiaries, to determine the appropriate Healthcare Common Procedure Coding System (HCPCS) code for Medicare billing. The PDAC contractor maintains the Durable Medical Equipment Coding System (DMECS). DMECS is an official source for Medicare DMEPOS product code verification and assignment.
The PDAC uses the manufacturer product specifications and measurements to determine appropriate codes. Certain products require a sample to be submitted along with the coding verification application. If a sample is not required, it is vital that the manufacturer's product literature is accurate and up-to-date.
Please be advised that the PDAC reserves the right to request/review updated product literature or request a product sample at any time in order to conduct a review of a previously coded product. From this review, it may be determined that the current HCPCS code that was assigned to a product, is not correct based upon coding guidelines that have changed from when the product was initially coded or changes that were made to the product by the manufacturer. This discrepancy could result in removal of the assigned code to the product or a new code assigned to the product.
If in the course of reviewing a website during product research/product review, the PDAC discovers a coding discrepancy, the manufacturer will be notified stating what was discovered, the corrective action to be taken to rectify the discrepancy and the consequences of not doing so within the time frame allowed.
If a DMEPOS supplier feels that a manufacturer is suggesting an improper code to bill Medicare, please contact the PDAC at 877.735.1326.