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Marcia Nusgart consulting with clients in Israel and the United States

Coding

A HCPCS code is needed to enable a provider to bill for a medical device or drug to third party payers. We understand the processes for obtaining new HCPCS codes for products and for verifying products to be included into already existing codes.

Marcia Nusgart is a well-known respected expert on obtaining new HCPCS codes and coding verification. She is the author of " HCPCS Coding: An Integral Part of Your Reimbursement Strategy." (Advances in Wound Care Dec. 2013)

Through the Coalitions' activities, we have taken on a leadership role and been at the forefront in meetings with the Centers for Medicare and Medicaid Services (CMS) to help modernize the HCPCS coding system so as to make it more timely, understandable and predictable for manufacturers.

Since the HCPCS coding system must now reflect the needs of all payers (instead of just Medicare) due to the Health Insurance Portability and Accountability Act (HIPAA), we have worked with CMS to ensure that a process is in place for the Agency to recognize State Medicaids' coding needs. We have also developed the contacts with State Medicaid agencies durable medical equipment, orthotics and prosthetics (DMEPOS) staff and have worked with them to obtain HCPCS codes.

For new or already existing medical devices or drugs, we will perform the following coding activities:

  • We will assess whether it needs a new code or whether an existing code is already in place that meets the needs of the company and product.

  • If a new code is needed, we will work with you to complete the HCPCS code application by making a compelling argument that will maximize the likelihood of a new code being given. This includes working with the appropriate clinical experts if needed to support the application.

After CMS publishes on its website the preliminary recommendations of the CMS HCPCS workgroup and schedules a public meeting to address all of the DMEPOS application recommendations, we will help plan and implement a strategy for your presentation at the meeting.

  • If a new code is not required, we will work with you to prepare and submit a code verification application to the Medicare Pricing Data Analysis and Coding Contractor (PDAC).

  • We will follow-up with the appropriate CMS or PDAC staff to ensure that they have received the documents submitted and are following the application procedures properly and expeditiously.

©2013 Nusgart Consulting LLC