Reporting the National Provider Identifier (NPI) on Claims for Reference Laboratory and Purchased Diagnostic Services Performed 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 contractor jurisdiction, the billing provider in addition to reporting its own NPI on the Medicare claim (as the billing provider), must also report its own NPI as the performing provider and annotate the claim with the name, address, and ZIP code of the performing provider.

You should be aware that your carrier or MAC will return as unprocessable your claims for reference laboratory or purchased diagnostic services that are performed outside the billing jurisdiction; if you submit them without your NPI in Item 32a, and the name, address, and ZIP code of the performing provider in Item 32 of the CMS-1500 form, or on the ANSI X12 837P electronic claim form in the appropriate data field.