Correct HCPCS coding for DME

Great question and something I have been lecturing and speaking about for quite some time. The Price Data Analysis Contractor (PDAC) is the Medicare contractor entrusted with providing validation for DME.

When requests are submitted by manufacturers and their consultants (I have done quite a few myself), the PDAC will review the applicaiton and often with a product sample to insure that the sample product and the supporting documentation, are consistent with the HCPCS code, for which the application is being submitted.

This process usually takes about 3 months before the PDAC issues a decision.

The information can easily be found on the PDAC's webbase database

https://www.dmepdac.com/palmetto/PDACv2.nsf/DID/B5UJSK54

This database is easy to navigate and regulalry updated.

Now for some caution: Most DMEPOS do not require PDAC validation. Thus one is likely to see few if any products listed for those products not requiring PDAC validation.

The rationale here is that it costs a substantial amount of time to gather the information to submit a product to PDAC. What would be the rationale for submitting a validation application for L3000 as Medicare routinely does not cover these devices? Additionally there are FDA costs to submit a PDAC application approaching over $10K.

For podiatry, therapeutic shoe inserts (A5512-A5514) manufactured by a third party and not the supplier, collagen dressings (A6010-A6024) and ankle training braces (L1906) typically require PDAC validation. Interestingly enough, therapeutic shoes (A5500) do not require validation, but many manufacturers do submit applications for these because they previously did require PDAC validation and most DPMs and Pedorthists tontinue to request hese letters.

Because the above codes are highly audited (both pre and post payment) one is well advised to retain a copy of the PDAC letter from the manufacturer or retain a copy of the DMECS window encapsulating proof of validation.

Typically the LCD and or attached policy article for a particular group of products will stipulate the need for PDAC validation.

Additionally, the PDAC maintains a searchable tool of all products requiring their validation, which may be found on their website at: https://www.dmepdac.com/palmetto/PDACv2.nsf/DIDC/Z5X289FZR6~Code%20Verification