Requesting a Coding Reconsideration
After the PDAC has rendered a requested HCPCS Level II coding decision by way of issuing a formal Coding Verification Determination letter to the requesting DMEPOS manufacturer/distributor, that entity has up to 45 days from the date of the letter to request a reconsideration if the following criteria is met:
- Additional information is submitted regarding the product’s features/functions that was not included with the original Coding Verification application, or
- Evidence is provided that the product’s design has changed since the original request was submitted.
Reconsideration requests must provide evidence to substantiate a reconsideration of the PDAC’s original coding determination. Reconsideration requests that do not meet the criteria outlined above will be denied a coding reconsideration.
The PDAC’s Reconsideration Request Form must be completed and sent to the PDAC within 45 days of the date of the original Coding Verification Determination letter, along with additional supporting documentation required by the above criteria. Upon receipt of the reconsideration request, the PDAC will thoroughly review the request and determine if a revised coding determination is deemed appropriate. Any reconsideration that is submitted after the 45-day timeframe will not be processed—instead, a new Coding Verification Review application must be submitted.
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.
If you would like to submit a request to the CMS HCPCS Workgroup, please complete and send the application located at www.cms.gov/MedHCPCSGenInfo/01_overview.asp to the CMS HCPCS Workgroup Coordinator at the address provided below.
Centers for Medicare & Medicaid Services
Kimberlee Combs-Miller, CMS HCPCS Workgroup Coordinator
7500 Security Blvd
Baltimore, Maryland 21244-1850