CMS 1500 Claim Form or Electronic Equivalent
Claims are billed as if the physician personally rendered the services.
Item 33 of the CMS 1500 claim form or electronic equivalent = individual physician National Provider Identifier (NPI)/group NPI
Claim submitted by a group practice - Item 24J = physician’s NPI (billing for "incident to")
Name of the physician or non-physician practitioner who performs the initial service and orders the non-physician service must appear in item 17
Enter the qualifier to the left of the dotted vertical line on item 17 followed by the name
DN= Referring Provider
DK =Ordering Provider
DQ =Supervising Provider
Example item 17:
Claims for the services listed below require the name and NPI of the certifying physician or non-physician practitioner of the therapy plan of care be entered as the referring physician in Items 17 and 17b.
physical therapy
occupational therapy
speech-language pathology services (including those furnished incident to a physician or non-physician practitioner)
Example 17a and 17b:
Enter the NPI of the supervisor (when the person who ordered the service is not supervising) in the lower un-shaded portion of item 24J.
Example Item 24J:
When directly supervising the "incident to" service, enter the signature of the ordering physician or non-physician practitioner in item 31.
Not supervising the "incident to" service, enter the signature of the physician or non-physician practitioner providing the direct supervision in item 31.
Example Items 24J and 31: