Using Modifier EY

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Mar 2nd, 2017

Some Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items require a detailed Written Order Prior to Dispensing (WOPD), while others require a Detailed Written Order (DWO) prior to billing. The specific requirements for an order are specified in the Medical Policy (Local Coverage Determination and/or Policy Article) for the specific item.

If you submit a claim to Medicare and specified requirements for an order are not met, you must append modifier EY (No physician or other licensed health care provider order for this item or service) to the claim line. This informs the Durable Medical Equipment Medicare Administrative Contractor (DMEMAC) that you do not have a physician's order for the item. Additionally, items submitted with the EY modifier must be on a separate claim from those items not requiring an EY modifier.

For Medicare, keep in mind, when the lack of a physician's order is expected to result in a statutory denial, an ABN is not required.