All claims
for Medicare covered services and items that are the result of a physician's
order or referral shall include the ordering/referring physician's name. See
Items 17a and 17b below for further guidance on reporting the
referring/ordering provider’s UPIN and/or NPI. The following
services/situations require the submission of the referring/ordering provider
information:
• Medicare covered services and items that are the result of a physician's order or referral;
•
Parenteral and enteral nutrition;
•
Immunosuppressive drug claims;
• Hepatitis
B claims;
•
Diagnostic laboratory services;
•
Diagnostic radiology services;
• Portable
x-ray services;
•
Consultative services;
• Durable
medical equipment;
• When the
ordering physician is also the performing physician (as often is the case with in-office
clinical laboratory tests);
• When a service is incident to the service of a physician or non-physician practitioner, the name of the physician or non-physician practitioner who performs the initial service and orders the non-physician service must appear in item 17;
• When a
physician extender or other limited licensed practitioner refers a patient for
consultative service, submit the name of the physician who is supervising the
limited licensed practitioner;
