US Medicare Provider and Supplier Enrollment (42 CFR Part 424 Subpart P) 424.507: Bill imaging, laboratory, DMEPOS, home health and hospice services only when ordered or certified by a physician or eligible professional who is identified by legal name and NPI and is enrolled in approved status or validly opted out

What does 424.507 require?

To be paid for ordered covered imaging, clinical laboratory services and DMEPOS items, the claim must show the legal name and NPI of the ordering physician or, where permitted, eligible professional, who must be enrolled in Medicare in an approved status or have validly opted out; where an unlicensed or non-enrolled licensed resident orders, the claim must identify the enrolled teaching physician as the ordering supplier, and a licensed resident may be identified only where State law permits and the resident is enrolled. Home health and hospice claims must identify by legal name and NPI the ordering or certifying physician (or, for home health, the physician assistant, nurse practitioner or clinical nurse specialist acting under State law), enrolled in approved status or validly opted out, with the same resident rules, and for hospice the certifying physician under 418.22(c). Contractors deny claims that do not meet these requirements.