Author Topic: PDAC issue  (Read 960 times)

pvtbiller

  • Newbie
  • *
  • Posts: 39
PDAC issue
« on: May 23, 2012, 07:27:28 PM »
has anyone ever dealt with this?
we submitted codes to PDAC - they assigned mostly misc codes.  then we asked for a reconsideration and came back with the same decision of mostly misc code being that it is a fairly new durable medical equipment item/product - there is no exsiting code to fit our product yet so we are going to file with c m s for our own this year.  i received an email saying that the medical directors have decided to review the product and went back to pdac to  make them now assign the non covered charges code on all our product.  I figured this is fine because it was the first generation of our product and these non covered codes are assigned to old product numbers  i went back to pdac to say we discontinued those product numbers and now the pdac reflects discontinued as of 2010.  we mfg the product under the same tradename but many changes and new parts have been added.

do you think i should go back to pdac to appeal their decision stating that our product is non covered because it is a luxury even though it is on the old product numbers but same tradename?

i believe as well that you are not required to go back to pdac with new products / models unless it is for glucose monitoring - can anyone confirm this?

as a side note - the item has been and keeps getting denied as non-covered even with the new item numbers and advances - so you think this is connected to pdac even though they donlt have the new item numbers?

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4761
    • Solutions Medical Billing
Re: PDAC issue
« Reply #1 on: May 24, 2012, 10:15:18 AM »
What is the product?  What does it do?  Hard to tell when we don't know what it does, is it a luxury or is it a medical necessity?
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