Are chiropractors required to report the ordering/referring provider on claims when billing for an X-ray or other diagnostic radiology service?

Yes. Claims for diagnostic radiology procedures must be submitted with the name, National Provider Identifier (NPI), and applicable provider qualifier of the provider who ordered the procedure, even though these services are non-covered when ordered or performed by a chiropractor. Radiology procedures submitted without this provider information will be rejected as unprocessable.  

Also, non-covered radiology procedures should be billed with a HCPCS modifier GY (statutorily non-covered). Failure to bill the GY HCPCS modifier may result in a ‘provider not eligible to order/refer’ denial, instead of a non-covered service denial.   

Instructions for reporting the ordering/referring provider on paper and electronic claims can be found in Items 17 (a-b) of the Interactive CMS-1500 Claim Form Tool.

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Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

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