Code Verification Review Requirement for Multi-Functional Ventilators

Joint DME MAC and PDAC Publication

The only products which may be billed using the following list of multi-function ventilator HCPCS codes are those that have received mandatory code verification review and are listed on the Product Classification List (PCL) of the Pricing, Data Analysis and Coding (PDAC) contractor website. The effective date of the code verification review requirement has been included next to each HCPCS code.

• E0467 - Code verification review requirement is effective for claims with dates of service on or after January 1, 2022.
• E0468 - Code verification review requirement is effective for claims with dates of service on or after October 1, 2024.

Refer to the Correct Billing and Coding of Ventilators publication, for detailed information pertaining to coding and billing of multifunction ventilators.

Correct coding is an essential element for correct claim payment. The PDAC contractor maintains a variety of resources to assist suppliers in determining the appropriate code for Medicare billing. For questions about correct coding, contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 a.m. to 5:00 p.m. ET, Monday through Friday. You may also visit the PDAC website to chat with a representative or select the Contact Us button at the top of the PDAC website for email, FAX, or postal mail information.