Referring, Ordering, & Supervising Provider Details

Explore these slides for guidance on completing fields in Loop 2310A, 2310D, 2420E, and Item 17.

Loop 2310A NM1 (Name of Referring Provider or Other Source) / Loop 2310D NM1 (Supervising) / Loop 2420E NM1 (Ordering) / Item 17

Complete when you refer or order an item.

Table 5: Loop 2310A NM1 (Name of Referring Provider or Other Source) / Loop 2310D NM1 (Supervising) / Loop 2420E NM1 (Ordering) / Item 17 Fields
Name of Referring Provider or Other Source	Source
Enter your name if you order or refer an item or service. All physicians who order services or refer Medicare patients must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in item 17 on the CMS-1500 or use Loop 2310D on the 837P. When a claim involves multiple referring, ordering, or supervising health care professionals, use a separate CMS-1500 for each ordering, referring, or supervising health care professional. Although item 17 says Referring Provider or Other Source, you must enter a health care professional referring, supervising, or ordering the service. Enter 1 of the following qualifiers to the left of the dotted vertical line on item 17 to show the role the physician or non-physician practitioner performs: DN (Referring Provider) DK (Ordering Provider) DQ (Supervising Provider)	Patient or Medicare records

Billing Tips for Loop 2310A NM1 (Referring Name) / Loop 2420E NM1 (Ordering Name) / Item 17

If the claim lists the ordering or referring health care professional or supplier, edits will verify that the person is Medicare enrolled.

The edits compare the first letter of the first name and the first 4 letters of the last name.
On claims, include only the health care professional's or supplier'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.

Situational

For circumstances that are situational and don’t apply to the health care professional or supplier billing for the service, leave the claim item blank.

Examples of Ordering or Referring Services

Generally, Medicare only reimburses for specific items or services when authorized physicians or other health care professionals order or refer them.

Examples of services and situations that require submission of the referring or ordering information include:

Parenteral and enteral nutrition
Immunosuppressive drug claims
Hepatitis B claims
Diagnostic laboratory services
Radiology, pathology, portable x-ray, or consultation services
DMEPOS

Loop 2310A NM109 (Referring) / Loop 2310D NM109 (Supervising) / Loop 2420E NM109 (Ordering) / Item 17b

Complete when a health care professional orders or refers the item or service.

Table 6: Loop 2310A NM109 (Referring) / Loop 2310D NM109 (Supervising) / Loop 2420E NM109 (Ordering) / Item 17b Fields
NPI	Source
Enter the NPI of the referring, supervising, or ordering physician or non-physician practitioner listed in item 17. For the 837P, include the NPI for the referring practitioner in Loop 2310A NM109 or Loop 2310D NM109 for the supervising practitioner. All practitioners who order services or refer Medicare patients must report their NPI to the health care professional billing for the service.	NPPES provides a searchable NPI Registry, or you can get the NPI from the referring or ordering health care professional.

NPI Explained

The NPI is the health care identifier used in Health Insurance Portability and Accountability Act (HIPAA) standard transactions.

It’s a 10-digit, intelligence-free numeric identifier. Intelligence-free means the numbers don’t carry information about health care professionals or suppliers, like their state, specialty, or supplier type.