Reporting the Ordering/Referring NPI on Claims for DMEPOS Items Dispensed Without a Physician’s Order

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.


General Billing Requirements - for DME, Prosthetics, Orthotic Devices, and Supplies



Part B suppliers and providers other than Home Health Agencies (HHAs) must bill DMEPOS to the Durable Medical Equipment Regional Carrier (DMERC), except claims for implanted DME. Implanted DME and supplies for the implanted equipment are billed to the local carrier.

Suppliers and providers must have a supplier billing number issued by the National Supplier Clearinghouse (NSC) prior to billing the DMERC.

Institutional providers bill their FI for prosthetics and orthotics devices and supplies. Generally, Medicare does not pay for DME in a facility. For hospital outpatient DME, bills go to the appropriate DMERC.

DMEPOS provided under a home heath plan of care may be billed either by the HHA or by the supplier (including the HHA with a supplier number if the HHA prefers to bill that way) to the DMERC. If the HHA chooses to bill to the RHHI, the HHA includes the DME on the PPS claim (32x or 33x). If the beneficiary is not under a plan of care and receives DMEPOS from a HHA, the agency uses bill type 34x.