DME MACs Release New Coding Guidelines for O&P Suppliers


The four Durable Medical Equipment Medicare Administrative Contractors (DME MAC), recently released a joint correct coding bulletin reminding DMEPOS suppliers that it is each supplier’s responsibility to select the proper HCPCS codes for billing.

To aid suppliers in their selection of the proper HCPCS code(s) the DME MACs provided the following tips:

  • Check the PDAC Product Classification Lists
  • Review DME MAC publications for coding bulletins and coding guidelines
  • Refer to the long code descriptor and select the code with the descriptor that most closely describes the item you are providing.
  • Most code narratives are written broadly to be all-inclusive. You may not find a specific code that perfectly matches a product. Use the code that most closely describes the item rather than a NOC (not otherwise classified) or miscellaneous code.
  • Review LCDs & Policy Articles for coding guidelines for additional information on the characteristics of products that meet a specific HCPCS code.
  • Don’t select a code based upon the fee schedule amount. HCPCS codes describe the product not the price.
  • Check with the PDAC. The PDAC may provide information, outside of a formal product review, that will assist you in code selection.

The bulletin also stressed that the DME MACs and the PDAC are the only entities that have the authority to assign HCPCS codes to specific products and if a supplier chooses to follow coding recommendations from outside sources; that these recommendations will have no “official standing”  during a possible claim review/audit.

AOPA is currently analyzing the joint bulletin and is working with the DME MACs to obtain some clarification and guidance on specific points raised in the bulletin. We will keep you posted of any new information.

Read the full bulletin.

Questions? Contact Devon Bernard at dbernard@AOPAnet.org or Joe McTernan at jmcternan@AOPAnet.org