Key Terms

Question 1

develop and maintain HCPCS Level II; composed of representatives from CMS, Medicaid State agencies, the Veterans Administration, and the Medicare Pricing, Data Analysis and Coding (PDAC) contractors.

Answer 1

CMS HCPCS Workgroup

Question 2

process Medicare durable medical equipment (DME) claims for defined geographic areas.

Answer 2

DME MAC

Question 3

defined by Medicare as equipment that can withstand repeated use, is primarily used to serve a medical purpose, is used in the patient’s home, and would not be used in the absence of illness or injury.

Answer 3

durable medical equipment (DME)

Question 4

include artificial limbs, braces, medications, surgical dressings, and wheelchairs.

Answer 4

durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)

Question 5

supply patients with durable medical equipment (DME) (e.g., canes, crutches); submit claims to DME Medicare administrative contractors (MACs) who are awarded contracts by CMS.

Answer 5

durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) dealers

Question 6

national codes published by CMS, which include five-character alphanumeric codes for procedures, services, and supplies not classified in CPT.

Answer 6

HCPCS Level II

Question 7

reported when a DMEPOS dealer submits a claim for a product or service for which there is no existing permanent national code.

Answer 7

miscellaneous codes

Question 8

maintained by the HCPCS National Panel, composed of representatives from the BlueCross BlueShield Association (BCBSA), the Health Insurance Association of America (HIAA), and CMS.

Answer 8

permanent national codes

Question 9

maintained by the CMS and other members of the HCPCS National Panel; independent of permanent national codes.

Answer 9

temporary codes

Question 10

coding system that consists of CPT, national codes (level II), and local codes (level III); local codes were discontinued in 2003; previously known as HCFA Common Procedure Coding System.

Answer 10

Healthcare Common Procedure Coding System

Question 11

responsible for providing suppliers and manufacturers with assistance in determining HCPCS codes to be used; PDACs replaced SADMERCs (statistical analysis durable medical equipment regional carriers).

Answer 11

Medicare Pricing, Data Analysis and Coding (PDAC) contractor

Question 12

commonly referred to as HCPCS Level II codes; include five-digit alphanumeric codes for procedures, services, and supplies that are not classified in CPT (e.g., J-codes are used to assign drugs administered).

Answer 12

national codes

Question 13

branch of medicine that deals with the design and fitting of orthopedic (relating to bone disorders) devices (e.g., braces).

Question 14

branch of medicine that deals with the design, production, and use of artificial body parts (e.g., artificial limbs).

Answer 14

prosthetics

Question 15

temporary additional payments (above the OPPS reimbursement rate) made for certain innovative medical devices, drugs, and biologicals provided to Medicare beneficiaries.

Answer 15

transitional pass-through payments