Article Detail - JD DME

Original Effective Date: 10/01/2000           
Revision Effective Date: 11/01/2013

DMERC Region D has received revised HCFA-1500 instructions from the Health Care Financing Administration (HCFA). These instructions have not been added to the DMERC Region D Supplier Manual due to an error with the format of the UPINs.

This supercedes the information currently in the DMERC Region D Supplier Manual. As of January 1999, surrogate UPIN NPP000 is no longer valid. Although surrogate UPIN INT000 is not listed, it is a valid UPIN and can be used. Below is Section 1009.2 from the Medicare Carriers Manual that lists the valid UPINs.

Surrogate UPINs

Providers/suppliers that submit claims for items or services are responsible for ensuring that the name and UPIN of the ordering/referring physician are obtained and submitted on Form HCFA-1500. The UPIN directory is the primary source for physician names and UPINs. However, some situations may exist in which physicians are not yet issued UPINs. In these instances, surrogate UPINs are to be used.

Surrogate UPINs, with the exception of RET000, are temporary and are to be used only until UPINs are assigned in accordance with the following conditions:

A. Residents - Billers are to use the six (6) character surrogate UPIN RES000 for a physician meeting the description of "intern, resident," or "fellow" in MCM, Part 3, Section 2020.8A, if the individual does not have a UPIN. However, if a resident already obtained a UPIN, that number is to be used instead of the resident surrogate. If a physician leaves the hospital for private practice and did not receive a UPIN, the physician may continue to use the surrogate used in the hospital until a UPIN is assigned. In this case, do not grant the physician an extended period (more than 30 days from entry into private practice) to apply for a UPIN. Encourage all physicians not assigned a UPIN to apply.

B. Physician with Military, Department of Veterans Affairs and Public Health Service - Physician/health care practitioners serving in the military or with the Department of Veterans Affairs or the Public Health Service are not exempt from the requirement to obtain a UPIN, particularly if they expect to provide services to Medicare beneficiaries or refer beneficiaries for other services. Until a UPIN is assigned, they are to use the following surrogate UPINs:

• VAD000 - Physicians serving on active duty in the military of the United States and those employed by the Department of Veterans Affairs.
• PHS000 - Physicians serving in the Public Health Service, including the Indian Health Service.

C. Retired Physicians - These physicians are not issued UPINs and are to use the surrogate RET000. Retired physicians who are assigned a UPIN must use the assigned UPIN.

D. "Special Use" UPIN - Situations may evolve that do not fall within the above categories. Therefore, one additional surrogate UPIN, OTH000 is provided. Instruct billers that they are to use OTH000 when:

• The service being billed is a service included in the CWF TOS code 3, 4 or 5;
• The ordering and performing physician (or other person) is not assigned a UPIN and does not qualify for any of the other surrogates listed above; and
• A UPIN is required, but the ordering/referring physician has not been assigned one and does not qualify for one of the other surrogates.