US · guidance
CMS Pub. 100-04, ch. 20, § 100.4
Reporting the Ordering/Referring NPI on Claims for DMEPOS
Items Dispensed Without a Physician’s Order
(Rev. 1368: Issued: 11-02-07; Effective: 05-23-08; Implementation: 04-07-08)
Chapter 5, section 5.2.1 of the Medicare Program Integrity Manual (PIM) states that, in
order for Medicare to make payment for an item of Durable Medical Equipment
Prosthetic, and Orthotic Supplies (DMEPOS), the DMEPOS supplier must obtain a
prescription from the
For Coordination of Benefit purposes, DMEPOS suppliers shall use the modifier EY (no
physician or other licensed health care provider order for this item or service) and report
their own name and National Provider Identifier (NPI) in the “Ordering/Referring
Provider Name” fields on claims submitted on or after May 23, 2008 to secure a
Medicare denial.
If the supplier has obtained a physician order for some, but not all, of the items provided
to a particular beneficiary, the supplier must submit a separate claim for the items with no
physician order.
History
(Rev. 1368: Issued: 11-02-07; Effective: 05-23-08; Implementation: 04-07-08)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
dacfab0ac555004b00734752620ad053a4e86644c87db7b1a9ef96cc1bfb83b6
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