1. Home /
  2. HCPCS Review /
  3. Request Code Verification /
  4. Product Sample Requirements

Product Sample Requirements

To prevent a delay in processing a coding verification application, a sample product must be submitted for certain DMEPOS products. Sample products submitted as part of this process should be identical to and exact examples of the product(s) that are dispensed to Medicare beneficiaries. For coding verification applications submitted on or after June 18, 2012, the product sample requirements are as follows:

Samples are REQUIRED for the following products:

  1. Compression stockings
  2. Diabetic shoes: Pair of shoes
  3. Diabetic shoe inserts (Includes custom fabricated by a central fabrication facility): Pair of inserts; each insert must be labeled as specified under Product Sample Provisions
  4. Support Surfaces – Gel and Foam (Excludes E0277)
  5. Nebulizer Machines – E0574 only
  6. Oral appliances for Obstructive Sleep Apnea
  7. Orthotics – Pre-fabricated (OTS and Custom-Fit), and custom fabricated by a manufacturer/central fabrication facility
  8. Ostomy appliances and barriers
  9. Pneumatic compression sleeves/garments
  10. Prosthetics – Prefabricated components, e.g. feet, knees
  11. Surgical Dressings
  12. Wheelchair Cushions and Backs (prefabricated)

NOTE: The above list is subject to change and may not be all-inclusive. If a product is not listed, please review the Coding Verification Application for instructions or call the PDAC Contact Center at (877) 735-1326, or email us using the PDAC Email Contact form located at www.dmepdac.com. The PDAC Contact Center hours of operation are Monday through Friday from 8:30 a.m. to 4:00 p.m. CT.

Please send only one sample unless otherwise noted in the Coding Verification Application.

Samples will not be returned.

Product Sample Provisions

Product samples submitted with coding verification applications should be identical to and exact examples of the products that are dispensed to Medicare beneficiaries.

Product samples must be identifiable as corresponding to the manufacturer, product name and model number information included on the coding verification application.

Coding verification applications with product samples that do not meet these requirements cannot be reviewed by the PDAC.

NOTE: Product labeling requirements as outlined per policy (e.g. Wheelchair Cushions) supersede the PDAC product sample requirements.

Product samples are NOT REQUIRED for the following products. Please DO NOT send samples.

Updated February 2015