Reporting National Provider Identifiers (NPI) on claims for Out-of-Jurisdiction Purchased Mammography Preventive Screening and Diagnostic Services
MLN Matters Number: MM6237
Related Change Request (CR) #: 6237
Related CR Release Date: October 31, 2008
Effective Date: December 1, 2008
Related CR Transmittal #: R1624CP
Implementation Date: December 1, 2008
Provider Types Affected
Physicians and other Part B providers/suppliers who submit bills to Medicare carriers and Medicare Administrative Contractors (A/B MAC) for mammography services provided to Medicare beneficiaries.
What You Need to Know
CR 6237, from which this article is taken provides billing instructions for using the NPI on paper, or electronically-submitted, Medicare claims for purchased mammography screening and diagnostic services when the service is performed outside of the carrier’s or A/B MAC’s claims processing jurisdiction. In this situation, billing providers should report their own NPI as the performing provider and also provide the name, address, and zip code of the performing physician/supplier.
You should be aware that carriers and AB MACs will return your out-of-jurisdiction, purchased mammography screening or diagnostic service claims as unprocessable if you submit them without the billing provider’s NPI; and the name, address, and ZIP code of the performing physician/supplier.
Additional Information
You can find more information about the reporting of the NPI on claims for out-of-jurisdiction purchased mammography preventive screening and diagnostic services by going to CR 6237, located at
For claims processing instructions on the CMS-1500 form and electronic form ANSI X12 837P you can refer to the Medicare Claims Processing Manual, Chapter 1 (General Billing Requirements), Section 10.1.1.1. (Claims Processing Instructions for Payment Jurisdiction for Claims Received on or after April 1, 2004). That manual is available at
http://www.cms.hhs.gov/Manuals/IOM/list.asp. To learn more about the NPI in general, visit
http://www.cms.hhs.gov/NationalProvidentStand.
If you have any questions, please contact our Provider Contact Center at our toll free number, 1-888-828-2092.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.