by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
August 13th, 2019
Level II Coding Procedures called HCPCS or Level II codes.
There are three main code sets and the
Dental codes are published and copyrighted by the American Dental Association (ADA) and used for billed dental procedures and supplies. An example of a Dental code is D0120 Periodic oral evaluation - established patient.
Miscellaneous codes are used when a supplier is submitting a bill for an item prior to an existing code being assigned to adequately describe the item or service. They may also be used while
- The item or service must be clearly described
- Pricing information
- Documentation explaining the reason for the service or item
Items Requiring Coding Verification Reviews
To avoid denials, be sure you verify with your supplier to determine if there is a more specific code that should be used. For coding questions contact the Pricing, Data Analysis, and Coding (PDAC) contractor to CMS. The PDAC is responsible for providing suppliers and manufacturers with assistance in determining which HCPCS code should be used to describe DMEPOS items for the purpose of billing Medicare. The PDAC has a toll-free helpline for this purpose, (877) 735-1326, Fax (803) 264-0648, or email. In addition, the PDAC publishes a product classification list on its website that lists individual items to code categories. More information about the PDAC and the PDAC’s product classification list can be found at dmepdac.com.
View the Code Verification Request Application Instructions webpage for application instructions and additional information.
- Application for Code Verification Review Form
- Reconsideration Form
- Additional Verification Information Form
- Section C/Product Specific
- Manufacturer Name Change (PDF, 13 KB) - Attestation regarding Manufacturer name change resulting from a corporate merger/purchase
- Model Number Addition (PDF, 13 KB) - Attestation regarding addition of model numbers. Must print/submit on company letterhead. Submit product literature and effective begin date for
- Private Label Agreement – Distributor Attestation (PDF, 16 KB) - Attestation Regarding Addition of New Manufacturer/Distributor Name Resulting from Private Label Agreement – Distributor Attestation
- Private Label Agreement – Manufacturer Attestation (PDF, 16 KB) - Attestation Regarding Addition of New Manufacturer/Distributor Name Resulting from Private Label Agreement – Manufacturer Attestation