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Issue 2006-05, May 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Rescind Change Request (CR) 4177- Eliminate the Use of Surrogate UPINs (OTH000) on Medicare Claims
Provider Types Affected
Physicians, non-physician practitioners, suppliers, and providers billing Medicare carriers, durable medical equipment regional carriers (DMERCs), fiscal intermediaries (FIs), or regional home health intermediaries (RHHIs) for diagnostic, radiology, consultation services, and equipment
Provider Action Needed
This article is based on Change Request (CR) 5019, which rescinds CR4177. CR4177 eliminated the use of the surrogate Unique Physician Identification Number (UPIN) OTH000 on claims submitted by billers, suppliers, physicians and non-physician practitioners. CR5019 instructs Medicare contractors to discontinue all work to eliminate the use of the Surrogate UPIN “OTH000” in claims processing, and continue to use Surrogate UPIN “OTH000” for submitted claims and other internal purposes.
Background
The Social Security Act (Section 1833(q); http://www.ssa.gov/OP_Home/ssact/title18/1833.htm  ) requires that:
- All physicians meeting the definition of a physician (Section 1861(r); http://www.ssa.gov/OP_Home/ssact/title18/1861.htm ) must have a UPIN,and
- All claims for services ordered or referred by one of these physicians must include the names and UPINs of the ordering/referring physician.
Currently, durable medical equipment (DME) suppliers, physicians, and non-physician practitioners are allowed to use a Surrogate UPIN to bill for the following:
- Diagnostic services;
- Radiology services;
- Consultation services; and
- Durable medical equipment.
CR4177 (Transmittal R752CP, dated November 10, 2005) instructed Medicare affiliated contractors (carriers, DMERCs, FIs, and RHHIs) not to accept the Surrogate UPIN “OTH000” on Medicare claims submitted by billers, suppliers, physicians, and non-physician practitioners.
However, because of the possibility that this will adversely impact the ability of providers to bill the Medicare program, the Centers for Medicare & Medicaid (CMS) is rescinding CR4177.
Surrogate UPINs are intended to be used during an interim period when a UPIN has been requested but has not yet been received. Currently, durable medical equipment (DME) suppliers, physicians, and non-physician practitioners are allowed to use a surrogate UPIN to bill for:
- Diagnostic services;
- Radiology services;
- Consultation services; and
- Durable medical equipment.
CR5019 instructs your Medicare contractor(s) to:
- Discontinue all work to eliminate the use of the surrogate UPIN “OTH000” in claims processing; and
- Continue to use surrogate UPIN “OTH000” for submitted claims and other internal purposes.
Implementation
The implementation date for CR5019 is April 3, 2006.
Additional Information
For complete details, please see the official instruction issued to your carrier/DMERC/FI/RHHI regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R145PI.pdf  on the CMS Web site.
Inquirers can obtain providers’ UPINs at http://www.upinregistry.com/ .
If you have any questions, please contact your carrier/DMERC/FI/RHHI at their toll-free number, which may be found at http://www.cms.hhs.gov/apps/contacts/ on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5019
Related Change Request (CR) #: 5019
Related CR Release Date: March 31, 2006
Effective Date: April 1, 2006
Related CR Transmittal #: R145PI
Implementation Date: April 3, 2006
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