Retired - Revised – Collagen Surgical Dressings – Coding Verification Review Requirement

Questions have recently come to the attention of the DME MACs and the PDAC concerning collagen dressings. The Local Coverage Determination Policy and Policy Article for Surgical Dressings contain the coverage criteria for surgical dressings as well as the Coding Guidelines for Surgical Dressings. The Surgical Dressings Policy Article states: Products containing multiple materials are categorized according to the clinically predominant component (e.g., alginate, collagen, foam, gauze, hydrocolloid, hydrogel). Other multi-component wound dressings not containing these specified components may be classified as composite or specialty absorptive dressings if the definition of these categories has been met. Multi-component products may not be unbundled and billed as the separate components of the dressing.

In the case of collagen dressings coded A6021, A6022, A6023 and A6024, the predominate component must be collagen.

Effective for claims with dates of service on or after June 1, 2013, the only products which may be billed to Medicare using code A6021, A6022, A6023 and A6024 are those for which a written coding verification has been made by the PDAC contractor and are listed on the Product Classification List in the Durable Medical Equipment Coding System (DMECS) maintained on the PDAC website, www.dmepdac.com. The DME MACs will be updating the Surgical Dressing Local Coverage Determination and Policy Article with this information.

All products currently listed on the Pricing, Data Analysis, and Coding (PDAC) contractor website with HCPCS codes A6021, A6022, A6023 and A6024 will be end dated effective June 1, 2013, with the exception of the predicate product and a product recently reviewed by CMS’ Alpha Numeric Workgroup. Manufacturers will be required to submit a new coding verification application to the PDAC for review and assignment of the correct code for products currently coded as A6021, A6022, A6023 and A6024.

Products which have not received coding verification review from the PDAC must be billed with code A9270.

The PDAC coding verification application required for these products is the Surgical Dressings application. This application is located on the PDAC website, https://www.dmepdac.com.

For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/