PDAC (SADMERC) Letters

Medicare HCPCS Coding Verification Letters, please click on the product item number below to view the letter

Note: Select codes may have changed, or “cross walked” to a revised code since the original issue date of these letters. Claim submissions bearing the original code should be honored for payment. For an up-to-date listing of original and “cross walked” codes for SAI Therapeutic Brands please follow this link:

https://www.dmepdac.com/dmecsapp/do/search

Click on “Search DMEPOS Product Classification List”; under Manufacturer/Distributor type in Surgical Appliance, then select GO.

Ankle Supports

C-307 Champion Neoprene Ankle Support
2092 OTC Ankle Stirrup Brace w/ Airform Pads
2093 OTC Ankle Stirrup w/ Honeycomb Pads
2371 OTC High-performance Ankle Brace
2372 OTC Canvas Ankle Splint
2375 OTC Ankle Stabilizer w/ Heel Locking Straps
2376 OTC Ankle Stabilizer w/ Criss-cross Strap & Molded Exoskeleton
2417 OTC Firm Elastic Pullover Ankle Support
2426 OTC Ankle Support w/ Viscoelastic Insert
2560 OTC Ankle Support w/ Spiral Stays

Back Supports

447-VHS Lumbosacral Support
457-VHS Lumbosacral Support
464-GHS Lumbosacral Orthosis
464-VHS Lumbosacral Orthosis
465-HS Lumbosacral Orthosis
465-VHS Lumbosacral Orthosis
486-HS Thoracolumbar Orthosis
643-VHS Lumbosacral Support
644-VHS Lumbosacral Support
645-VHS Lumbosacral Support
957 Knight-Taylor Thoracolumbar Orthosis
962 Chair-Back Lumbosacral Orthosis
2884 OTC Lightweight Lumbosacral Support
2886 OTC Heavy Duty Sacro Brace w/ Thermo Pad
2890 OTC Lumbosacral Support w/ Abdominal Uplift
2891 OTC Lightweight Elastic Lumbosacral Support
2892 OTC Lumbosacral Orthosis
2893 OTC Lumbosacral Support w/ Abdominal Uplift
2895 OTC LumboTEK Elastic Lumbosacral Support
2896 OTC LumboTEK2 Lumbosacral Orthosis

Cervical Supports

2394 OTC Soft Foam Cervical Collar

Elbow Supports

2423 OTC Tennis Elbow Strap with Lightweight Air Pad

Hand-Wrist Supports

C-128 Champion Neoprene Wraparound Wrist Support
C-303 Champion Neoprene Wrist-Thumb Support
C-304 Champion Neoprene Cock-up Wrist Support
C-305 Champion Neoprene Thumb Splint
2072 OTC Soft Lightweight Thumb Immobilizer
2073 OTC Molded Plastic Thumb Splint
2081 Exolite Low-profile Wrist Brace
2082 OTC Lightweight 6" Wrist Splint
2083 OTC Lightweight Breathable 8" Wrist Splint
2086 OTC 6” Wrist-Thumb Splint
2087 OTC Lightweight Breathable 8" Wrist-Thumb Splint
2360 OTC SoftFit Suede Finish Wrist Brace
2362 OTC Cock-up Wrist Splint
2364 OTC Professional's Choice Cock-up Wrist Splint
2389 OTC Occupational Wrist Support
2418 OTC Elastic Pullover Wrist Support

Hernia Supports

2956 OTC Lightweight Beige BilateralHernia Support
2958 OTC Lightweight Single Hernia Support
2958D OTC Lightweight Bilateral Hernia Support

Home Medical Equipment

210404 PCP Adjustable Folding Cane w/ Orthopedic Handle
5040 PCP Sitz Bath
5091S PCP Adjustable Aluminum Crutches - Tall Adult
5026 Commode Chair, Aluminum w/ Removable Back
5526 Commode Chair Coated Aluminum w/ Removable Back
5595-BL PCP Low-profile, Large Base Quad Cane
6230 PCP Ring Cushion - Inflatable
6233 PCP Ring Cushion - Carved Foam
7002 PCP Adjustable Shower Chair w/o Back
7013 PCP Molded Raised Toilet Seat
7255 PCP Coated Tub Bar

Knee Supports

C-141 Champion Neoprene Knee Support w/ Oval Pad
C-142 Champion Neoprene Knee Support w/ Hor-Shu Pad
C-143 Champion Neoprene Knee Support w/ Pad & Hinged Bars
C-144 Champion Neoprene Knee Support w/ Pad & Spiral Stays
C-306 Champion Neoprene Knee Support w/ Open Patella
C-308 Champion Neoprene Knee Stabilizer w/ Spiral Stays
C-309Champion Neoprene Knee Support w/ Stabilizer Pad
C-310 Champion Neoprene Knee Stabilizer w/ Hinged Bars
C-311 Champion Neoprene Knee Stabilizer Wrap w/ Hinged Bars
C-312 Champion Neoprene Knee Stabilizer Wrap w/ Hinged Stays
C-314 Champion Neoprene Knee Wrap w/ Stabilizer Pad
2416 OTC Elastic Pullover Knee Support
2422 OTC KNEED-IT Therapeutic Knee Guard
2425 OTC Knee Support w/ Viscoelastic Insert
2540 OTC Knee Stabilizer Wrap for Osteoarthritis
2541 OTC Orthotex Knee Stabilizer w/ Spiral Stays
2542 OTC Orthotex Knee Stabilizer Wrap w/ Spiral Stays
2543 OTC Orthotex Knee Stabilizer w/ Hinged Bars
2544 OTC Orthotex Knee Stabilizer Wrap w/ Hinged Bars
2545 OTC Knee Support w/ Front Opening, Pressure Pads
2546 OTC Orthotex Knee Support w/ Stabilizer Pads
2548 OTC Orthotex Knee Sstabilizer w/ Hinged Bars
2549 OTC Orthotex Knee Sstabilizer Wrap w/ Hinged Bars
2553-P OTC Knee Support w/ Spiral Stays, Open Patella
2554 OTC Knee Brace w/ Hinged Bars
2555 OTC Knee Support w/ Pressure Pads, Open Patella
2555-V OTC Knee Support w/ Expansion Panel, Pressure Pads