Author Topic: Requesting New Code Sets From Medicare  (Read 1872 times)

pvtbiller

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Requesting New Code Sets From Medicare
« on: October 25, 2011, 09:49:37 PM »
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

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Re: Requesting New Code Sets From Medicare
« Reply #1 on: October 26, 2011, 06:48:25 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.
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pvtbiller

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Re: Requesting New Code Sets From Medicare
« Reply #2 on: October 26, 2011, 09:14:39 AM »
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

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Re: Requesting New Code Sets From Medicare
« Reply #3 on: October 27, 2011, 08:49:56 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.
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pvtbiller

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Re: Requesting New Code Sets From Medicare
« Reply #4 on: October 29, 2011, 10:15:50 PM »
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?

Michele

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Re: Requesting New Code Sets From Medicare
« Reply #5 on: November 04, 2011, 08:47:43 AM »
No dealings with PDAC.  I still would contact a provider rep for one of the larger carriers.  They may be able to help.
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