Medical Billing Forum
Coding => Coding => : pvtbiller 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?
-
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.
-
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?
-
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.
-
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?
-
No dealings with PDAC. I still would contact a provider rep for one of the larger carriers. They may be able to help.