Provider NPI Details | Medicare Billing: CMS-1450 & 837I

These slides show you how to complete the provider NPI information in the CMS-1450 and the 837I.

Loop 2010AA/FL 56

Table 7: Loop 2010AA/FL 56 Field
NPI — Billing Provider	Source
Use this field to report the NPI of the provider submitting the bill.	NPPES offers a searchable NPI Registry.

If you list the ordering or referring provider on the claim, the edits will verify the patient’s Medicare enrollment.

The edits compare the first letter of the first name and the first 4 letters of the last name.
On claims, include only the provider's first and last name as they appear in the Order and Referring tool on the CMS Data webpage.
Don’t list middle names, initials, or suffixes like MD or RPNA in the claim's ordering and referring fields. Medicare will deny a claim if it includes a middle name, initial, or suffix.

Medicare requires this field when the claim has any services other than nonscheduled transportation services.

Table 8: Loop 2310A/FL 76 Field
Attending Provider — NPI/QUAL/ID — Last/First	Source
Report the attending provider’s name and NPI in FL 76.	NPPES offers a searchable NPI Registry or you may get the NPI from the attending physician.

An institutional provider can't submit its own NPI, except in the following situations:

When billing solely for flu, pneumococcal, and COVID-19 shots and their administration on a claim
When roster billing flu and pneumococcal shots and their administration
When billing only for a self-referred screening mammography service
When the provider only has an individual (Type-1) NPI as a physician or practitioner-owned sole proprietor

Report the NPI of the operating physician if a surgical procedure was performed.

Table 9: Loop 2310B/FL 77 Field
Operating Physician- NPI/QUAL/ID – Last/First	Source
When reporting a surgical procedure on the claim, report the name and NPI of the operating physician, the person with the main responsibility for performing the surgical procedures reported.	NPPES offers a searchable NPI registry or you can get the NPI from the referring or ordering health care professional.

Report the NPI of any other provider not otherwise listed on the claim.

Table 10: Loop 2310C/FL 78 and 79 Fields
Other Provider NPI/QUAL/ID — Last/First	Source
Report the first and last name and NPI for any referring provider, other operating physician, or rendering provider if not otherwise listed on the claim. Report up to 2 other providers in FL 78 and FL 79.	NPPES offers a searchable NPI Registry or you may get the NPI from the other provider.

We’ll now review the claim information related to patients.