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SADMERC

The Statistical Analysis Durable Medical Equipment Regional Carrier or "SADMERC" provides services under contract to the Health Care Financing Administration (HCFA) since January 1993. Among the SADMERC's responsibilities is to assist suppliers and manufacturers in the proper use of the HCFA Common Procedure Coding System (HCPCS). The HCPCS is used to identify items of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for purposes of Medicare billing.

HCFA's goal in assigning coding responsibilities to one contractor is to ensure uniform coding interpretation for all DMEPOS items. Manufacturers and suppliers are instructed by HCFA and through the DMERC supplier manual and advisories to contact the SADMERC to obtain proper billing codes for any DMEPOS items.

The SADMERC handles these queries in a number of ways designed to be conducive to a supplier or manufacturer getting a prompt, accurate response on how to code a specific product. These include:

• Operating a HCPCS Helpline to field telephone inquiries from suppliers regarding proper coding. The SADMERC responds to in excess of 8,000 coding calls per month.
• Written inquiries from suppliers and manufacturers for coding guidance.
• Coding verification requests, i.e., written requests supplemented by extensive product documentation used to ascertain the correct code.
• To respond to these coding queries, the SADMERC maintains customer service staff with DMEPOS and coding expertise. The SADMERC HCPCS Unit has Registered Nurses with extensive experience in the use of DMEPOS for patient care in nursing home, home health and hospital settings. Additionally, the SADMERC has a physician Medical Advisor on staff to provide clinical expertise to coding reviews.

The SADMERC has also established a network of consultants to provide additional expertise. Among the consultants available to the SADMERC to render impartial professional opinions regarding the coding structure, clinical issues, or specific product categories, are Certified Orthotists and Rehab Specialists from across the country.

SADMERC staff thoroughly analyze product information and assess product features, dimensions, and functionality to determine the correct code. In the case of coding verification and new code requests, the SADMERC consults with Coding Coordinators (registered nurses) and often confers with the Medical Directors (physicians) of the four Durable Medical Equipment Regional Carriers (DMERCs).

The SADMERC represents the four DMERCs on the HCFA Alpha-Numeric Workgroup, the entity charged with maintaining the coding structure for all Medicare claim types. All DMEPOS products sent directly to this HCFA body are referred to the SADMERC for review and recommendation. Final decisions of the Alpha-Numeric Workgroup are shared with the National Editorial Panel, which includes private sector health insurers. Again, the SADMERC represents the DMERCs on all DEMPOS issues presented to the National Editorial Panel by the HCFA Alpha-Numeric Workgroup and assists in the annual update and publication of coding revisions.

SADMERC (HCPCS help line): (877) 735-1326

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