Written by Cascade Clinical Educator, Nina Bondre, CPO, FAAOP

In today’s ever-changing billing and reimbursement landscape, it is crucial to stay current on the latest rules and requirements. Part of this process is understanding where to quickly access relevant information to ensure you are following the most current billing guidelines. Confirming a product is PDAC authorized is important per the latest announcement from the DME MACs, PDAC, and CMS that all claims with dates of service on or after January 1, 2021, must include PDAC approved products when billing under the following codes:

• L5856
• L5857
• L5858
• L5973
• L5980
• L5987

When billing for the above codes, staff members can use the PDAC website to confirm that the product under review is PDAC approved. Follow the steps below to see how!

1. Go to dmepdac.com and click on the first option “DMECS.”

2. Select “Product Classification List” to arrive at the page shown below.

3. You can then search by a variety of fields – I find it easiest to search by code, and then sort to quickly see recently approved items.

For this example, we will look up products that have been PDAC approved for L5987:

• Type in L5987
• Click “Search.” You will receive a list of results
• Click on “Effective Begin Date” twice to sort from most recent to oldest

4. You can also search by product name or manufacturer in case the product you are searching for is not in the Lcode group you initially looked in.

A few important things to remember:

• Even if a product is PDAC approved, there is no guarantee of reimbursement.
• The website can lag a few days between a manufacturer receiving approval for a product and that product appearing on the PDAC website. In those cases it may be best to contact the manufacturer for a copy of the PDAC approval letter.
• In cases where the name of the product has changed, it can be helpful to search by manufacturer.
• Some products may also have an “Effective End Date” for approval and it is important to be mindful of an expired approval.

Have questions? Please feel free to contact Nina at nbondre@cascade-usa.com or directly at 443-610-1552.