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.