[serina.breen@comcast.net]

Do I need to execute an ABN when using the EY modifier (No Doctor's Order on
File) when delivering an item requiring an order prior to delivery? Or are
ABN's only used in situations where I have a doctor's order, but I think it
lacks medical necessity?



I do NOT have an order from a physician for seat lift mechanism which
requires an order prior to delivery. The patient doesn't want to wait for
the doctor to write an order because they want the item now and they are ok
with Medicare not covering the item. Will I need to obtain an ABN in this
situation if I'm going to bill using the EY modifier?





Best Regards,

Serina Breen

Freedom Mobility Center

586 Parker Ave - Rodeo, CA 94572

Tel 510.799.9920

Fax 510.280.0778

Serina.Breen@comcast.net

[DMEisgoodfun]

billing EY w/o ABN will deny as CO. Get the ABN and bill with GA EY

[DeeDee]

Yes, you need the ABN and your justification on the ABN is "No Physician Order"

[HMEFRIENDS]

My understanding is that when you do not have a prescription for an item, suppliers are not required to file a claim under "mandatory claims submission", therefore, in that case an ABN is not required. However, to be save, my recommendation is to obtain an ABN anyway and have the patient mark Option 2 so that you do not have to file a claim at all.

If the patient wants a claim filed anyway and marks Option 1, you will need to submit the claim with an EY modifier. If you try to submit the claim with a GA & EY it will reject out. You can only use one or the other modifer.