If you are involved with durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), you should be aware of updates to PDAC (pricing, coding analysis, and coding) approved bracing.
Essentially, PDAC approved orthoses are bracing products that are allowed to be billed to Medicare or other insurance providers.
A crucial component to insurance payments is the correct coding! So today on the blog we will cover coding requirements and recent updates set forth by PDAC.
What is PDAC?
PDAC is the contractor to the Centers for Medicare & Medicaid Services (CMS) for pricing, coding analysis, and coding (hence the name PDAC). It maintains the Durable Medical Equipment Coding System (DMECS). You can explore the DMECS on the PDAC’s website here.
HCPCS stands for the Healthcare Common Procedure Coding System. It is a collection of standardized codes, (including codes for orthoses) used in insurance claims processed by Medicare and other insurers. PDAC provides suppliers and manufacturers help in the determination of which HCPCS codes should be used to classify medical equipment that will be billed to Medicare.
The PDAC reviews products that fall under Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) and provides code verification and assignments. The PDAC also publishes and maintains a Product Classification List on its website.
In April 2022, the PDAC website published an update to the code verification review requirement for lower limb and lumbar sacral orthoses. These certain lower limb and lumbar sacral orthoses now require prior authorization as a condition of payment. (Review our previous blog post on Prior Authorization Changes.)
According to the update, three lower limb orthoses (HCPCS codes L1832, L1833, and L1851) and two lumbar sacral orthoses (HCPCS codes L0648 and L0650) are scheduled for implementation.
Products can be billed under these codes ONLY if they have obtained a coding verification review from PDAC and are published on PDAC’s product classification list.
Items Requiring Coding Verification Reviews
View the current list of HCPCS codes and local coverage determinations that require coding verification review on the PDAC website here.
Code Verification Review Application
Another recent update related to the Code Verification Review Application, made effective on October 1, 2021, is that PDAC will only accept forms found on the PDAC website. The form for orthotic (bracing only) can be found here.
PDAC provides a variety of resources to DMEPOS suppliers. For more information, visit the PDAC website or call the toll free helpline at 877-735-1326.
We Can Help
Elite Medical Supply is a DMEPOS supplier that stays up-to-date on PDAC approved bracing, updates published on the PDAC website, and items requiring coding verification review. Should you have any questions about this information, don’t hesitate to contact us today.