Compliance Is Key to PDAC Coding Verifications

Medicare Pricing Data Analysis and Coding (PDAC) verification rules are often misunderstood, specifically when it pertains to coding and documentation. While many O&P suppliers have only heard of these rules, some have experienced claim denials due to lack of compliance. Unfortunately, Medicare policy falls short in educating the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) community about how to be compliant with this coding requirement. For suppliers to prevent claim denials, it is essential to review and apply compliance best practices to ensure all claim requirements for PDAC verification are satisfied.

Since not all Healthcare Common Procedure Coding System (HCPCS) codes require PDAC verification, the first step is identification. The PDAC website has a helpful resource on its website (dmepdac.com) that lists all O&P specific HCPCS codes that require PDAC verification, including codes for orthoses, prostheses, and diabetic inserts. If applicable, these codes are also identified in the respective Policy Article for each type of device.