CMS Clarifies NPI Use on Certain Claims
The Centers for Medicare & Medicaid Services (CMS) issued Transmittal 1690, Change Request (CR) 6362, Feb. 27, to clarify a National Provider Identifier (NPI) reporting policy on claims for reference laboratory and purchased diagnostic services purchased outside the billing jurisdiction.
When a provider bills for a reference laboratory service listed on the Clinical Laboratory Fee Schedule for a purchased diagnostic service performed by a provider located in another jurisdiction, the billing provider should report its own NPI as both the billing and performing provider and annotate the claim with the name, address, and ZIP code of the performing provider.
Whereas this practice was once discretionary, it is now required.
For auditing purposes, the billing provider should also note in the clinical record the performing provider’s NPI.