NPI now required for select physician lab service referrals

Last modified: June 15, 2021

Now in effect — national provider identifiers (NPIs) will be required for all Medicare claims submitted for the following:

• Clinical laboratories for ordered tests
• Imaging centers for ordered imaging procedures
• Suppliers of Durable Medical Equipment, Prosthetics/Orthotics & Supplies (DMEPOS) types of items for such ordered items, such as Part A home health agencies (HHA)

All claims must be submitted with a valid ordering or referring practitioner NPI in box 17b on the 1500 claim form. Furthermore, the submission of ordering and referring health care professional information for a practitioner who is not eligible to order such services could result in a claim resubmission. 

PCA-1-21-01618-UHN-News_05192021