Coding Verification/Assignment of HCPCS Codes
The Pricing, Data Analysis and Coding (PDAC) contractor maintains the Durable Medical Equipment Coding System (DMECS). DMECS is an official source for Medicare Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) product code verification and assignment.
Coding verification is the process that allows manufacturers/distributors to request a coding decision on a DMEPOS item. It is the responsibility of the PDAC to review DMEPOS products to determine the appropriate Healthcare Common Procedure Coding System (HCPCS) code for Medicare billing. Click on Request Code Verification to start the process.
Coding verification by the PDAC is a voluntary process unless mandated by Durable Medical Equipment Medicare Administrative Contractor (DME MAC) policy. (For further information, refer to the specific Local Coverage Determination (LCD) or Policy Article at http://www.cms.gov/medicare-coverage-database/indexes/national-and-local-indexes.aspx).
Benefits of submitting products to PDAC for coding verification include:
The product and assigned HCPCS code will be listed in DMECS on the Product Classification List (PCL).
DMEPOS Suppliers have access to the correct HCPCS code to use for billing DMEPOS claims by utilizing DMECS.
If a product has not undergone coding verification by the PDAC, it may result in denial of payments by Medicare, overpayment assessment and/or a law enforcement referral by the DME MACs following a post-payment review.
The PDAC will review the manufacturer product specifications to determine an appropriate HCPCS code(s) based on established policy as published in DME MAC LCDs, Policy Articles and other Advisory Articles as applicable. In the absence of published coding guidelines, the PDAC may seek input from the DME MAC Medical Directors and CMS.
PDAC reserves the right to re-review and request a sample of any previously coded product if it determines the product may have changed, coding guidelines have changed from when the product was initially coded or in the course of a normal systematic review of HCPCS coding decisions. If this re-review determines the current HCPCS code assigned is no longer correct, a new code may be assigned to the product.