Author Topic: Requesting New Code Sets From Medicare  (Read 3401 times)

pvtbiller

  • Newbie
  • *
  • Posts: 39
Requesting New Code Sets From Medicare
« on: October 26, 2011, 12:49:37 AM »
I work for a company that is the sole (DME) provider and manufacturer of a product.  The product does not fit into any existing HCPCS code.  When asked PDAC for new codes, they keep coming back with the MISC code which pays $7.00.  Our cost is over $5000.00.  Anyone know what to do at this point - we need brand new codes - I am going to appeal the PDAC decsion to medicare.  Has anyone ever requested new codes and been successful?

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Requesting New Code Sets From Medicare
« Reply #1 on: October 26, 2011, 09:48:25 AM »
No experience with getting a  new code assigned.  Do you submit an invoice, or other form of showing cost?  I'm assuming you appeal when processed as $7.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

pvtbiller

  • Newbie
  • *
  • Posts: 39
Re: Requesting New Code Sets From Medicare
« Reply #2 on: October 26, 2011, 12:14:39 PM »
Well, unfortunately there was a service doing it for them and they did not.  I will now be doing this.  We do send a claim to medicare under the misc at this point but it just is not working - any suggestions?

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Requesting New Code Sets From Medicare
« Reply #3 on: October 27, 2011, 11:49:56 AM »
Have they ever gotten paid what they should have from anyone?  I would contact one of the provider reps for a larger carrier (BCBS) and ask how to resolve this.  Ask how they want it billed and what you can do to make sure they are reimbursed fairly.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

pvtbiller

  • Newbie
  • *
  • Posts: 39
Re: Requesting New Code Sets From Medicare
« Reply #4 on: October 30, 2011, 01:15:50 AM »
they have not gotten paid from anyone - they received coding from PDAC as a misc code but i think it should be prosthetic - anyone ever deal with pdac?

Medical Billing Forum

Re: Requesting New Code Sets From Medicare
« Reply #4 on: October 30, 2011, 01:15:50 AM »

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Requesting New Code Sets From Medicare
« Reply #5 on: November 04, 2011, 11:47:43 AM »
No dealings with PDAC.  I still would contact a provider rep for one of the larger carriers.  They may be able to help.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Medical Billing Forum

Re: Requesting New Code Sets From Medicare
« Reply #5 on: November 04, 2011, 11:47:43 AM »