Coding > Coding

Requesting New Code Sets From Medicare

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pvtbiller:
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:
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.

pvtbiller:
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:
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.

pvtbiller:
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?

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