Code Verification Review Requirement for Articulating Digit(s) and Prosthetic Hands - Revised
Joint DME MAC Publication and PDAC Article
Effective for claims with dates of service on or after January 1, 2022, the only products that may be billed using Healthcare Common Procedure Coding System (HCPCS) codes L6715-TERMINAL DEVICE, MULTIPLE ARTICULATING DIGIT, INCLUDES MOTOR(S), INITIAL ISSUE OR REPLACEMENT and/or L6880-ELECTRIC HAND, SWITCH OR MYOELECTRIC CONTROLLED, INDEPENDENTLY ARTICULATING DIGITS, ANY GRASP PATTERN OR COMBINATION OF GRASP PATTERNS, INCLUDES MOTOR(S), 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. Manufacturers with products in this category of items must submit their products for coding verification review by August 31, 2021.
To assist manufacturers and suppliers with correct coding, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) are requiring mandatory code verification review by the PDAC contractor for upper extremity devices that might qualify for HCPCS codes L6880 and/or L6715. The application for the coding verification review is located on the PDAC website.
The Centers for Medicare and Medicaid Services (CMS) Program Integrity Manual (CMS Pub. 100-08), Chapter 3, Sections 3.3.B and 126.96.36.199 specify that for Medicare claims, only CMS and the DME MACs have the authority to establish HCPCS Level II Coding Guidelines. Pursuant to 42 CFR § 414.40 and 45 CFR § 162.1002, CMS has the authority to assign and manage HCPCS codes (create, delete, change code narrative, etc.).
Additional information on the coding and billing of HCPCS codes L6715 and L6880 may be found in the Joint DME MAC publication Correct Coding - Articulating Digit(s) and Prosthetic Hands – Revised published in October 2019, on the DME MAC and PDAC websites.
If you have questions, please contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 am to 5 pm 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 page for email inquiry, FAX, or postal mail information.
|06/04/2021||Published on PDAC website|
|06/15/2021||Revised to add "and/or" to clarify that products coded as either L6880 or L6715 must be code verified, added hyperlink to PDAC website, updated L6880 HCPCS description|