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Marilyn Posted Tue 25th of February, 2014 17:29:39 PM

Patients referred to Nutritionist, Psychologist and Chiropractic, is it mandatory to have the referring physicians/npi in boxes 17/17b on the cms1500 form. We bill electronically.

SuperCoder Answered Mon 03rd of March, 2014 07:19:38 AM

Yes. NPs are expected to submit claims to the Part B carrier under their own NPI number. Previously when NPs rendered services they entered their carrier assigned PIN number on the CMS 1500 billing form. Now that identifier must be an NPI. NPs may assign their numbers to a group practice for purposes of billing. There are no limitations on CPT codes as long as they are recognized by Medicare as reimbursable codes for physician services. Evaluation and Management Guidelines should be consulted to insure accurate coding.
When NPs are ordering or referring services, they must use their NPI to order or refer. Medicare will not pay for referral/ordered services or items unless the name and NPI number of the referring entity is on the claim. Only physicians, nurse practitioners, clinical nurse specialists, physician assistants and certified nurse midwives are allowed to refer/order services or items for beneficiaries.

Marilyn Posted Wed 05th of March, 2014 13:02:18 PM

I'm sorry, my question was when patients are "referred to our clinic's" Registered Dieticians, Physchologists, and LPC's for counseling and Chiropratic treatment, do we need to have the "referring" provider(s)name and NPI in box 17/17b?

For "self referred" patient(s), would the Rendering Provider's info be entered in box 17/17b?

Thank you.

Marilyn Posted Wed 05th of March, 2014 13:06:22 PM

So basically, will need the patient(s) Doctors name and NPI in box 17/17b, when they are referred by their medical doctor.

SuperCoder Answered Wed 05th of March, 2014 15:11:13 PM

Exactly, as stated above

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