Ordering, Referring and Prescribing: NPI Requirements for DME and Clinical Laboratory Providers
Effective February 1, 2027, DME and Clinical Laboratory providers billing Medi-Cal must include a valid 10-digit Individual (Type 1) Ordering provider NPI on applicable claims. The Ordering NPI must be actively enrolled as a participating Medi-Cal provider by May 1, 2027. Claims will be denied if the Ordering provider NPI is missing, invalid, inactive, not on NPPES, or is a group NPI. Specific HCPCS codes with replacement modifiers are exempt from this requirement.