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Reconsideration Request

When a DMEPOS manufacturer/distributor entity is dissatisfied with a PDAC HCPCS Level II coding decision, a reconsideration request may be submitted if the following criteria is met.

In addition to the above met criteria, the below requirements apply as well.

Request Must Include

Request will be Rejected When

Request Acknowledgement and Completion Notification

CMS HCPCS Workgroup

Within CMS, there is a CMS HCPCS Workgroup comprised of representatives of the major components of CMS, as well as other consultants from pertinent Federal agencies. The CMS HCPCS Workgroup is responsible for maintaining the permanent, national HCPCS Level II codes. If a HCPCS Level II code does not exist for a particular product, if the description for an existing code is not adequate or appropriate, or, an existing code needs to be deleted, any interested party may submit a request to the CMS HCPCS Workgroup to modify the HCPCS.

To submit a request to the CMS HCPCS Workgroup, complete and send the application available on the CMS HCPCS - General Information webpage to the CMS HCPCS Workgroup Coordinator at the address below.

Centers for Medicare & Medicaid Services
Kimberlee Combs-Miller, CMS HCPCS Workgroup Coordinator
C5-08-27
7500 Security Blvd
Baltimore, Maryland 21244-1850

Contested Reconsideration

The PDAC Contested Reconsideration Application process provides a mechanism for an entity other than a product’s manufacturer to challenge the assigned HCPCS code. The process begins with submitting a Contested Reconsideration Application for the product. Careful attention should be made by the submitter’s rationale for the changing the assigned code. View Contested Reconsideration Request webpage for details.