Retired - Collagen Surgical Dressings – Coding Verification Review Requirement

Recently the Centers for Medicare & Medicaid Services (CMS) made a coding and benefit category determination on certain collagen surgical dressings. Based on this determination, all collagen surgical dressings are being compared to the characteristics of the predicate product. A predicate product is the product(s) used in the establishment of the original code set and is the product to which all other products are compared. In the case of collagen dressings, the predicate product contained 90% collagen. For a product to be assigned to a collagen dressing category, the dressing must contain at a minimum, 90% collagen, unless otherwise specified within the HCPCS code (e.g. per gram of collagen).

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 the product recently reviewed by CMS. 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.

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, https://www.dmepdac.com. 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, 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 email the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com

The Surgical Dressing Local Coverage Determination and Policy Article will be updated with this information at a later date.