What is the Difference Between the PDAC and the DME MACS?

Function of the PDAC

One function of the Pricing Data Analysis and Coding Contractor is to determine an appropriate Healthcare Common Procedure Coding System (HCPCS) code to use when submitting claims to Medicare. A HCPCS code identifies the durable medical equipment, prosthetics, orthotics, and/or supplies (DMEPOS) being billed.

PDAC Responsibilities

• Operate a Contact Center to provide coding advice and guidance
• Maintain DMECS, a web-based interactive tool that provides HCPCS coding assistance and national fee schedule information
• Respond to written inquiries requesting HCPCS coding assistance
• Coordinate and participate in requests for HCPCS Coding Verification Reviews
• Maintain a NDC/HCPCS crosswalk applicable for DMEMAC billing

Who is Calling the PDAC?

• Suppliers
• Manufacturers
• Distributors
• OIG (Office of Inspector General)
• CMS (Centers for Medicare & Medicaid Services)
• Consultants
• Attorneys
• Doctor Offices
• Pharmacies
• Billing Services
• Other Insurance Carriers
• DME MACS
• Medicaid
• Attorney General Office

PDAC Can:

• Provide HCPCS coding determinations
• Provide allowables for items that are on the DMEPOS Fee Schedule

PDAC Cannot:

• Provide codes for items that are not billable to the DME MACS
• Answer coverage or policy questions including the use of modifiers
• Address claim inquiries
• Provide beneficiary eligibility
• Assist with questions concerning claim form(s)
• Address required documentation for claims submission
• Provide allowables for items that are not on the DMEPOS Fee Schedule
• Provide publications such as the Supplier Manual, bulletins or DMEPOS Fee Schedules
• Address CMN or DIF Information
• Assist with Type of Service or Place of Service codes
• Provide Diagnosis Codes

Type of Calls Referred to the DME MAC:

• Coverage and Utilization Questions
• Eligibility
• Claim Inquiries
• Claim Form(s)
• Required Documentation
• Allowables for items priced by reasonable charge and individually considered items
• Publications: Supplier Manual, bulletins and Fee Schedules
• CMN/DIF Information
• Type of Service and Place of Service Codes