The new version, CMS 1500 (rev 02-12) form has been being used now for just over two months after it’s April 1st implementation.  The most common error that providers are making when completing the new CMS form is on box 17, the referring/ordering/supervising physician field.  On the new CMS 1500 (rev 02-12) a qualifier is required to indicate whether the provider is referring, ordering, or supervising.  Below is a recap:


On the newly revised CMS 1500 (rev 02-12) form which will become mandatory by Medicare on April 1, 2014, providers will have to use the appropriate qualifier to indicate referring, ordering and supervising physicians. On the old CMS 1500 (08-05) form it wasn’t necessary to differentiate between referring, ordering and supervising physicians. The provider’s name and NPI were simply entered in box 17. With the new form Medicare is requiring that the appropriate qualifier is used to differentiate between referring, ordering, and supervising physicians by using the following qualifiers:


◦DN -> to indicate a Referring Provider
◦DK -> to indicate an Ordering Provider
◦DQ -> to indicate a Supervising Provider


These qualifiers should be entered to the left of the dotted vertical line in box 17. If the qualifier is not present the services will be denied.