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Admini&-d Services ucWD 4P Street SouthPO Box 6757Fargo, ND 581 08-6757PDACMedicare Pricing, Data Analysis<strong>and</strong> <strong>Coding</strong>October 2,2008MEI3LM INDUSTRIES NCATI'N: DAVID JACOBS. PRESIDENT DME DIVISIONONE MEDLINE PLACEMIINDELEIN IL 60060Re: Rollator (Model # MDS868 10 Xref #: 6361041Dear Mr. Jacobs:This letter is in response to your recent inquiry for coding verification of the above listedproductls) manufactured <strong>and</strong>or distributed by your company.It is our determination that the Medicare HCPCS code(s) to bill the four DME MedicareAdministrative Contractors (DME MACs) i slare:E0143 WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT<strong>and</strong>E0156 SEAT ATTACHMENT. WALKERThis HCPCS coding decision applies to the submitted prduct(s) as presented to arid reviewed bythe Pricing, Data Analysis <strong>and</strong> <strong>Coding</strong> (PDAC). Any modifications to the product(s) couldchange the HCPCS code <strong>and</strong> would need to be reviewed for coding verification. The assignmentof a HCPCS code to the product(s) should in no way be construed as an approval or endorsementof the product(s) by PDAC or Medicare, nor does it imply or guarantee claim reimbursement orcoverage. For questions regarding claim coverage or reimbursement, please contact your DMEMAC jurisdiction.Should you disagree with this coding decisjon, a reconsideration can be requested. Thereconsideration form is located on the PDAC website Cwww.dmepdac.com) under theHCPCS Review tab. The PDAC will reconsider the request if made within 45 days of thedate of this letter <strong>and</strong> additional supporting documentation is provided. If a request forreconsideration Is made after 45 days, the request is treated as a new <strong>Coding</strong> VerificationReview <strong>and</strong> a complete application must be submitted, along with t be additionaldocumentation supporting the request.
W0 42" Street SouthPO BOX 6757Fargo, ND 581 08-6757PDACMedicare Pricing, Data Analysis -3 ----<strong>and</strong> <strong>Coding</strong>.*Should you have questions, regarding this decision, you may contact the PDAC Contact Centerat the address listed above or by telephone at (877) 735-1326.Sincerely,~~ndayeir, RNPDAC <strong>Coding</strong> Analyst
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