Documentation Required for HCPCS Coding Determination


The Statistical Durable Medical Equipment Regional Carrier (SADMERC) provides HCPCS coding assistance to suppliers and manufacturers by telephone, email, voice mail, and postal mail to ensure proper coding of durable medical equipment, prosthetics, orthotics, and supplies. The following information is required to make a HCPCS coding determination when requesting coding assistance via telephone, email, voice mail, or postal mail:

Medical Equipment, Supplies/Accessories, Miscellaneous Items, Surgical Dressings, Enteral and Parenteral Nutrition, Support Surfaces, Manual Wheelchairs, Power Mobility Devices, Wheelchair Cushions, Diabetic Shoes and Inserts

  1. Manufacturer's name
  2. Full complete name the item is marketed under to the public
  3. Manufacturer's product/model number
  4. If the item is listed in a distributor's catalog, give the name of the distributor and catalog number
  5. Give a complete description of what the item is; it's function; if it is used with another piece of equipment, specify the equipment
  6. If this is a part, what piece of equipment is it going on; is it given at initial issue of the equipment; is it a replacement item on patient owned or rented equipment
  7. If it is a supply/accessory, what equipment is it used for or with
  8. Date of service
  9. If available, please provide the web site which shows the product

Orthotics and Prosthetics

  1. The same information listed under Medical Equipment and Supplies is required for orthotics and prosthetics
  2. What part of the body is the item used on

Medications

  1. Name of drug (please ensure accurate spelling of the drug name)
  2. National Drug Code (NDC)
  3. How is it administered to the patient: intramuscular; subcutaneous; oral; IV gravity; external infusion pump; compressor; metered dose inhaler; insulin infusion pump; is it given in a physician's office or a facility (the route of administration or the setting in which it is given may make a difference in how the drug is coded based on policy guidelines)
  4. What is the patient specifically taking it for; do not generalize such as saying it is for cancer; specify if it is taken to fight cancer or it is taken for nausea due to cancer drugs (what the patient is taking it for may make a difference in how the drug is coded based on policy guidelines)

NOTE: SADMERC does not assist with the following functions:

  • Modifiers
  • Coverage
  • Documentation
  • Place of service codes
  • Diagnosis codes
  • Utilization
  • Patient eligibility

Please contact your DME/MAC for assistance with these items.

Published by Palmetto GBA as the SADMERC, July 10, 2007. Republished by Noridian as the PDAC, August 2008. Republished by Palmetto GBA as the PDAC, January 2019.


Last Updated: 07/10/2007