The question really is whether or not Medicare's Price Data Analysis Contractor (PDAC) is mandated to review and issue a validation of every product with a HCPCS.
The answer is simple. It would be impossible for the PDAC to review every HCPCS code and every device with a HCPCS code. The PDAC (www.dmepdac.com) has a listing of those HCPCS codes which require their inspection, review and validation.
Most DMEPOS podiatric physicians (and dare I say most suppliers) use do not require PDAC validation. The PDAC has enough review work to do as it is with those HCPCS codes which are mandated to be reviewed and validated.
The listing of mandated codes required to be reviewed is listed on the PDAC website. Additionally, the PDAC maintains an on-line listing in a database (DMECS). The DMECS database is a treasure trove of information where one can search in a variety of ways for a specific product, thus allowing you to see whether or not a specific product is validated or not. when the product was first validated, if it is current or was deleted. Again, simply because a product is not validated, does not mean you cannot bill for it.
Some common examples of HCPCS codes requiring validation are:
L1906, A5512-A5514. Note that A5500 (therapeutic shoes) do not require validation, but the inserts (when you do not self manufacture) do require validation.
Thus one should not bill for a HCPCS code which requires validation, but for which a specific product is not listed in the DMECS Product Classification System.
Last, one can always call the PDAC at their call center (this is listed on their homepage) in order to inquire on a specific product.
The question really is whether or not Medicare's Price Data Analysis Contractor (PDAC) is mandated to review and issue a validation of every product with a HCPCS.
The answer is simple. It would be impossible for the PDAC to review every HCPCS code and every device with a HCPCS code. The PDAC (www.dmepdac.com) has a listing of those HCPCS codes which require their inspection, review and validation.
Most DMEPOS podiatric physicians (and dare I say most suppliers) use do not require PDAC validation. The PDAC has enough review work to do as it is with those HCPCS codes which are mandated to be reviewed and validated.
The listing of mandated codes required to be reviewed is listed on the PDAC website. Additionally, the PDAC maintains an on-line listing in a database (DMECS). The DMECS database is a treasure trove of information where one can search in a variety of ways for a specific product, thus allowing you to see whether or not a specific product is validated or not. when the product was first validated, if it is current or was deleted. Again, simply because a product is not validated, does not mean you cannot bill for it.
Some common examples of HCPCS codes requiring validation are:
L1906, A5512-A5514. Note that A5500 (therapeutic shoes) do not require validation, but the inserts (when you do not self manufacture) do require validation.
Thus one should not bill for a HCPCS code which requires validation, but for which a specific product is not listed in the DMECS Product Classification System.
Last, one can always call the PDAC at their call center (this is listed on their homepage) in order to inquire on a specific product.