NPI: NPI Requirements for Medicare DME Suppliers
In accordance with the NPI Final Rule, Durable Medical Equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers are required to obtain a National Provider Identifier (NPI) for every business location. The only exception to this requirement is when a DMEPOS supplier is a sole proprietor (or considered an individual). A sole proprietor (Entity Type 1) is eligible for only one NPI regardless of the number of business locations.
The requirement for DMEPOS suppliers to obtain an NPI for every practice location also applies to DMEPOS suppliers who are enrolled with Medi-Cal. Providers with a Medi-Cal number prefix beginning with “DME,” “XA,” “GXA,” “GFA,” “XB,” “GXB,” “GFB,” “XC,” “GXC,” or “GFC” must register a separate NPI subpart for each Medi-Cal number that begins with any of these prefixes. The only exception is for those providers who are a sole proprietor (Entity Type 1), as defined by the HIPAA – NPI Final Rule.
Failure to comply with this requirement may result in delayed processing or rejection of both Medicare crossover or direct bill Medi-Cal claims.
More information about NPI can be found in the NPI area of the CMS Web site. Providers may apply for an NPI online at the National Plan and Provider Enumeration System (NPPES) Web site or call the NPI Enumerator at 1-800-465-3203 to request a paper application.
For more information about Medicare subpart expectations, please review the Medicare Subpart Guidance Paper.Note:
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