CMS to Deny Claims if Ordering Physician Not Identified Properly

March 7, 2013


On May 1, CMS will begin denying reimbursement claims if the physician or medical practitioner who orders the test is not identified on the claim, is not enrolled with Medicare, or is not of a specialty that may order or refer the service being billed.


More information is available from CMS:  “Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856)” at


CMS also offers a tool to check if a physician/practitioner is enrolled. Go to; then click on “Ordering & Referring Information” on the left.