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David McGill Blogger

Alphabet Soup: HCPCS & PDAC

Posted by David McGill | September 04, 2013

We regularly receive questions about PDAC "approvals" and correct coding. The purpose of this post is to briefly explain the related but different roles of two entities involved in O&P coding.

1. The HCPCS Coding Workgroup

This panel, consisting of 30+ members, has two central functions. First, it creates new codes for devices not described by the current list of L codes. Ossur's PROPRIO FOOT (L5973) and POWER KNEE (L5859) are examples of products that the HCPCS Coding Workgroup reviewed and created new L codes for. 

Second, this workgroup also modifies current code language if it believes that doing so will better describe a device family. 

2. The PDAC

Unlike the HCPCS Coding Workgroup, the PDAC is not a part of Medicare's Central Office in Baltimore. Rather, it's an independent contractor. Currently, Noridian is the private entity tasked with fulfilling the PDAC's responsibilities. While the PDAC must perform multiple functions, it figures in the world of coding by issuing coding verifications for products already described by existing L codes.

What does this mean for you?

Both the HCPCS Coding Workgroup's and the PDAC's coding decisions dictate how you bill Medicare for O&P devices. Once either of these entities has issued a coding decision, you must bill Medicare consistent with that directive!

To reiterate, the HCPCS Workgroup creates new codes for products that fall outside the current code set, while PDAC issues coding verifications for products already described by existing L codes. 

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