Durable Medical Equipment Ordered With Surrogate Unique Physician Identification Numbers (UPIN)

Original Effective Date: 10/01/2002
Revision Effective Date: 11/01/2013

Section 1833(q) of the Social Security Act requires that all physicians who meet the §1861(r) definition of a physician must have a UPIN. All claims for services ordered or referred by a physician must include the name and UPIN of the ordering/referring physician.

A physician or supplier who bills Medicare for a service or item must show the name and UPIN of the ordering/referring physician on the claim form, if that service or item was the result of an order or referral from a physician. If the ordering physician is also the performing physician, the physician must enter his/her name and assigned UPIN as the ordering physician. If the ordering/referring physician is not assigned a UPIN, the biller may use a surrogate UPIN.

A physician or supplier who submits a claim for a service or item is responsible for ensuring that the name and UPIN of the ordering/referring physician is obtained and submitted on Form CMS-1500. Physician names and UPINs can be found in the UPIN directory. If the physician's UPIN has not yet been issued, a surrogate UPIN is to be used only until an individual UPIN has been assigned. Surrogate UPINs are used under these conditions:

  • OTH000: To be used when the ordering/referring physician has not yet been assigned and does not qualify for one of the other surrogate UPINs. If a UPIN has been assigned, the physician will be notified of the assigned UPIN. If a UPIN has not been assigned, the physician will be notified of the need to file an application for a UPIN and sent an application form.
  • RES000: To be used by physicians meeting the description of "intern," "resident," or "fellow."
  • VAD000: To be used by physicians serving on active duty in the United States military and those employed by the Department of Veterans Affairs.
  • PHS000: To be used by physicians serving in the Public Health Service, including the Indian Health Service.
  • RET000: To be used by retired physicians who have not been issued a UPIN. (Retired physicians who have been assigned a UPIN must use the assigned UPIN.)
     

It is the Centers for Medicare & Medicaid Services goal to assign a UPIN to every physician/health care practitioner and group practice that meets the Medicare definition.

            Last Updated Wed, 10 May 2017 09:55:48 +0000