Pricing, Data Analysis and Coding (PDAC)

Noridian is contracted by CMS to assist suppliers and manufacturers in the proper use of the Healthcare Common Procedure Coding System (HCPCS) through the Pricing, Coding and Data Analysis (PDAC). The HCPCS is used to identify items of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for purposes of Medicare billing.

The PDAC plays a key role in the regionalization of DMEPOS claim processing. Some of their responsibilities include:

  • Provide data analysis support to the DME Unified Program Integrity Contractors (UPICs)
  • Guide manufacturers and suppliers on the proper use of the HCPCS through product reviews and decisions
  • Assist CMS with DMEPOS fee schedules

Contact Information

View the PDAC website.

DMECS - Online Coding Assistance from the PDAC

The DMECS (Durable Medical Equipment Coding System) is an online application that will provide HCPCS coding assistance and national pricing information 24 hours a day. DMECS is designed to help Medicare providers and suppliers quickly classify DMEPOS by combining information from a variety of sources to make HCPCS coding determinations for claim submission to the DME MACs easier. The first phase of DMECS includes a HCPCS and fee schedule look-up with capabilities to print or download information.

Coding Jurisdiction

HCPCS codes in the D, H, M, P and R ranges are always billed to the local carrier.

Oral Anticancer Drugs - National Drug Codes

The Oral Anti-Cancer Drug  (OACD) file can be found on the PDAC website.

Items Requiring Coding Verification Reviews by PDAC

Manufacturers and suppliers are reminded that a number of items require coding verification review by the PDAC contractor. As noted in the Local Coverage Determinations (LCD) and related Policy Articles that include these codes, claims for these HCPCS codes will be denied if the products requiring coding verification review are not listed on the PDAC Product Classification List. Coding decisions are updated frequently. Suppliers should refer to the Product Classification List often to ensure DMEPOS items billed have been coded by the PDAC. The Product Classification List is located on Durable Medical Equipment Coding System (DMECS) which is located on the PDAC website.

The table below reflects the current list of HCPCS codes that require coding verification review by the PDAC along with the applicable LCD or Advisory Article for the code(s) and the date (i.e., claims with dates of service on or after) for when the requirement became effective.

A list of HCPCS codes requiring coding verification review by the PDAC can be found on the PDAC website.

The PDAC coding verification applications required for these products are located on the PDAC website.

 

Last Updated Nov 20, 2018