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Medi-CalMedicaid · Documentation · Provider Bulletin · CAHigh impact

Ordering, Referring and Prescribing: NPI Requirements for DME and Clinical Laboratory Providers

Act
by May 1, 2027
Effective date
Feb 1, 2027
Identified
Oct 17, 2026

Summary

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.

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What to do

by May 1, 2027 · 5 steps
01Billing team must verify that all Ordering providers have active Medi-Cal enrollment and valid Individual (Type 1) NPIs registered on NPPES.
02Beginning February 1, 2027: Update billing software to require and validate a 10-digit Individual Ordering provider NPI on all DME and Clinical Laboratory claims submitted to Medi-Cal, except for claims with HCPCS codes E1340, K0739, K0740, V5014, X2996, or X2998 billed with replacement modifier (RP or RB).
03Verify that submitted NPIs are not group NPIs.
04Providers submitting Ordering NPIs that are missing, invalid, inactive, or not Type 1 Individual will receive claim denials.
05Enroll providers using DHCS PAVE (Provider Application and Validation for Enrollment) portal.

Codes mentioned

E1340K0739K0740V5014X2996X2998

Original notice

Ordering, Referring and Prescribing: NPI Requirements for DME and Clinical Laboratory Providers
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.
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Related policy hubs

Medi-Cal policiesCA policy changesCode E1340Code K0739Code K0740Code V5014Code X2996Code X2998

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