The current LCD states: "Items represented by code A5510 reflect compression molding to the patient's foot over time through the heat and pressure generated by wearing a shoe with the insert present. When inquiring about a HCPCS code to determine if the code is billable or payable to a DME MAC, first check the National Coverage Determination (NCD), the Local Coverage Determination (LCD), and the DME MAC website to determine whether the code is billable and/or payable.Įxample: HCPCS code A5510 is currently listed on DMECS as a billable code to the DME MAC. Specific details can be found on the applicable DME MAC website for which you are billing. If the HCPCS code is billable to the DME MAC it does not necessarily mean it is payable.Ī payable HCPCS code is one that will be considered for payment by the DME MACs if the item meets the definition of DME, falls under a benefit category, and is covered under other general DME guidelines. A billable HCPCS code will display as active on DMECS (no end date). One may think the two are the same however this is not the case.Ī billable HCPCS code is one that is submitted on a claim to the DME MAC. The PDAC receives frequent inquiries regarding a billable HCPCS code and a payable HCPCS code. Click on the Request Updates to DMECS link for instructions on requesting updates to the PCL.īillable HCPCS Codes vs. Manufacturers/Distributors are responsible to notify the PDAC of any changes involving their products posted on the PCL.If any product information is inaccurate on the coding verification letter or on the PCL, the manufacturer should notify the PDAC immediately. It is the responsibility of the manufacturer to verify their DMEPOS product information is listed accurately on the PCL and education on the assigned code is provided to their distributors and/or suppliers.
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News - industry news & Find-A-Code updates.Marketplace - recommended products & services.
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Library - buy digital books from Find-A-Code.Bookstore - buy physical books & cheat sheets.Subjects - Audits, E&M, HIPAA, Practice Mgt, etc.Specialties - Cardiology, ENT, Family Practice, etc.Payers - Medicare, Medicaid, BC/BS, Aetna, etc.Facilities & Organizations - ACOs, Hospitals, etc.