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Linda Collins Blogger

What Does a PDAC Letter Really Mean?

Posted by Linda Collins | April 05, 2017

We are continually asked if a product has a "PDAC letter." What   does this really mean and which products actually require coding verification letters? Let's start with a review of PDAC.

PDAC is the pricing, data, analysis, and coding (PDAC), contractor to CMS. PDAC is responsible for (among other things) providing suppliers and manufacturers with assistance in determining which HCPCS code should be used to describe DMEPOS items for the purpose of billing Medicare. In addition, the PDAC publishes a product classification list on its website that lists individual items to code categories, available at

For our purposes, we're going to focus on one of the PDAC responsibilities: its role as a verifier of correct coding for prosthetic and orthotic devices.

Does the PDAC review all prosthetic and orthotic components?

No. Historically, the PDAC has not required manufacturers to submit any prosthetic components for coding verification. This means that any prosthetic devices listed on the PDAC's website either (a) were submitted voluntarily by the device's manufacturer, or (b) received a code from Medicare's HCPCS Coding Workgroup, a decision that PDAC is required to follow and that it publishes on its site.

On the orthotic side, PDAC has required mandatory submission of products, but only for certain L codes. In the instance where PDAC requires verification in order to bill a particular code, you cannot bill Medicare fora device using that code unless it has gone through the verification process. A list of the few HCPCS codes which do require PDAC verification is found here.

Do I need copies of the PDAC letters?

Once PDAC reviews a product and verifies the HCPCS code assigned to that product, the manufacturer receives a letter with this information. It is not necessary for the supplier to have a copy of PDAC letters. It is necessary to check the PDAC website to determine you are using the correct HCPCS code, especially when the code does require the product to be listed prior to billing.

If a product doesn't have PDAC verification, how do I know what code to use for it?

Virtually all product manufacturers suggest potentially applicable code(s) for non-PDAC-verified devices. But remember, manufacturer and third-party suggestions are only that: suggestions.

Ultimately, you remain responsible for what codes you submit in conjunction with your claim. Neither the PDAC nor the MACs consider "the manufacturer told me to do this" a compelling basis for reversing a denied claim.

If a product is not listed on PDAC, can we bill Medicare?

Yes, as long as it is not one of the orthotic codes requiring review. Currently, only L1906, L1845 and all spinal orthoses codes do require review. This means that prior to submitting a claim using one of these codes you should check the PDAC site and confirm the product is listed. 

What does this mean for you? 

When a product doesn't have PDAC verification, you must carefully examine the suggested codes, compare them to the functions and features of the product you're delivering, and make sure you're comfortable that they map directly to the code language in a defensible way.

A final thought, if a product is listed on PDAC it means the code assigned to the product is the appropriate HCPCS code to use when billing. It does not mean you are exempt from audits or other claims reviews. It does not mean the product is officially "approved" by Medicare. It simply gives you guidance as to what HCPCS code to use when billing the product.

As always, if you have questions, contact us at [email protected]

Össur R&R

The Source for O&P Reimbursement & Regulatory News & Analysis

If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at [email protected]