Effective April 1, Medicare carriers will no longer accept “surrogate” physician identification numbers. Currently, providers and suppliers are allowed to bill Medicare using OTH000, a generic Unique Physician Identification Number (UPIN), when the ordering or referring physician’s UPIN is unknown or unavailable.

Surrogate UPINs were originally intended for use when a physician has requested but not yet received a UPIN. In practice, however, many physicians’ billing systems use OTH000 as a default, even when a valid UPIN is available.

To stop this unsafe billing practice, claims submitted with surrogate UPIN OTH000 after April 1 will be returned as unprocessable. Physicians should hold claims until a UPIN is obtained. Returned claims can be resubmitted within one year.

Contact: CMA’s reimbursement help line, 888/401-5911.