PDAC Verification Explained

What You Need to Know

The PDAC is a CMS contractor whose responsibilities include providing coding verifications for durable medical equipment, prosthetics, orthotics, and supplies. Verification is a voluntary process for product manufacturers and distributors unless the DME MAC's specifically require it for certain classes of devices. The PDAC identifies products requiring verification through the HCPCS coding system; specifically, by flagging certain L-codes that are subject to verification. Once the PDAC verifies a product, it publishes its decision online in the Durable Medical Equipment Coding System (DMECS) database.

PDAC verification is only mandatory for specific categories of orthotic and prosthetic devices. This includes some spinal orthoses, knee braces, AFO's/KAFO's, upper limb orthoses, and lower and upper limb prosthetic components.

 What this Means for You

The most important thing for you to understand is which products require PDAC verification. If you bill Medicare for a product that requires verification but the manufacturer has not submitted it to the PDAC, your claim will get denied. Click here to see all codes requiring PDAC verification.

In addition, for claims involving devices that require PDAC verification, you should use the DMECS online system to confirm that the product you plan on using has gone through that process. This can also help you with commercial health plans, as some insurers follow Medicare's requirements for PDAC verification. You can use this information to show a health plan that the device has been verified for the codes you are billing.