Ordering, Referring, Prescribing (ORP) Providers

Updated: July 2026

Purpose

This policy explains North Dakota Medicaid requirements for an ordering/referring/prescribing (ORP) provider's National Provider Identifier (NPI) on professional claims. 42 CFR §455.440 requires state Medicaid programs to ensure claims for payment for items and services that were ordered or referred contain the NPI of the physician or other professional who ordered or referred such items or services.

Applicability

Eligible Providers

The policy applies to the following services and provider types. The types of services/items identified are services where federal and/or state regulations require orders, referrals, or prescriptions for a North Dakota Medicaid member to receive an item or service.

Allowable ORP Provider Types

Allowable provider types under each service may be listed as the ORP provider on the claim if their scope of practice allows for the order/referral/prescription. ORP providers must be enrolled with ND Medicaid.

Services and Limits

General Provider Policies

The General Provider Policies details basic coverage requirements for all services. Basic coverage requirements include:

The provider must be enrolled in ND Medicaid;
Services must be medically necessary;
The member must be eligible on the date of service; and
If applicable, the service has an approved service authorization.

The Procedure Code Look-up Tool can be used to identify if a procedure code is covered by ND Medicaid along with code specific details such as ORP requirements, Service Authorization requirements, and current rates.

Behavioral Health Rehabilitative Services

*The rendering provider may order services with an asterisk.

Screening, Triage, and Referral Leading to Assessment*
Behavioral Assessment
Crisis Intervention*
Behavioral Intervention
Individual and Group Counseling
Behavioral Health Counseling and Therapy
Intensive in-home for Children
Nursing Assessment and Evaluation
Skills Training and Integration
Assessment for Alleged Abuse and/or Neglect and Recommended Plan of Care (formerly known as Forensic Interview) *

Allowed ORP Provider Types and Specialties

Provider Type 020 - Physicians (Allopathic and Osteopathic)

Specialty/Taxonomy Codes - all

Provider Type 036 - Physician Assistants (PA) and Advanced Practice Registered Nurses (FNP, NP-C, CNS, CNM, CRNA)

Specialty/Taxonomy Codes – all

Provider Type 010 – Behavioral Health & Social Services Providers

Behavioral Health Specialty and Taxonomy Codes
- Behavioral Analyst (BA)
  - 567 - 103K00000X
- Behavior Modification Specialist (BMS)488 - 174400000X
- Licensed Addiction Counselors (LAC)
  - 155 - 101YA0400X
- Licensed Associate Professional Counselors (LAPC)
  - 177 - 101YP2500X
- Licensed Clinical Social Worker (LCSW)
  - 191 - 1041C0700X
- Licensed Master Social Workers (LMSW)
  - 445 - 104100000X
- Licensed Baccalaureate Social Worker (LBSW)
  - 625 - 104100000X
- Licensed Professional Clinical Counselor (LPCC)
  - 190 - 101YP2500X
- Licensed Professional Counselor (LPC)
  - 194 - 101YP2500X
- Licensed Marriage and Family Therapist (LMFT)
  - 403 - 106H00000X
- Licensed Psychologist
  - 050 - 103T00000X
  - 523 - 103TC2200X
  - 543 - 103TC0700X
  - 669 - 103TA0400X
  - 670 - 103TA0700X
  - 671 - 103TB0200X
  - 672 - 103TC1900X
  - 674 - 103TF0000X
  - 675 - 103TF0200X
  - 676 - 103TP2701X
  - 677 - 103TH0004X
  - 678 - 103TH0100X
  - 679 - 103TM1800X
  - 681 - 103TR0400X
  - 682 - 103TS0200X
  - 074 - 103G00000X

BAs, BMSs, LAPCs, LBSWs can only be listed as the ORP for the following services:

Screening, Triage, and Referral Leading to Assessment;
Crisis Intervention; and
Assessment for Alleged Abuse and/or Neglect and Recommended Plan of Care (formerly known as Forensic Interview).

Community Health Workers

Allowed ORP Provider Types and Specialties

Provider Type 020 - Physicians (Allopathic and Osteopathic)

Specialty/Taxonomy Codes – all

Provider Type 036 - Physician Assistants (PA) and Advanced Practice Registered Nurses (FNP, NP-C, CNS, CNM, CRNA)

Specialty/Taxonomy Codes – all

Provider Type 012 – Dental Providers

Dental Specialty and Taxonomy Codes
- 001 - 1223G0001X
- 019 - 122300000X
- 062 - 1223E0200X
- 063 - 1223P0221X
- 064 - 1223X0400X
- 065 - 1223P0300X
- 066 - 1223P0700X
- 212 - 1223S0112X
- 515 - 1223X0400X

Provider Type 018 – Pharmacy Service Providers

Pharmacist Specialty and Taxonomy Codes
- 253 - 183500000X
- 658 - 1835P2201X
- 791 - 1835G0303X
- 792 - 1835N0905X
- 793 - 1835N1003X
- 794 - 1835X0200X
- 796 - 1835P1200X
- 797 - 1835P1300X

Provider Type 010 – Behavioral Health & Social Services Providers

Behavioral Health Specialty and Taxonomy Codes

Licensed Addiction Counselors (LAC)
- 155 - 101YA0400X
Licensed Psychologist
- 050 - 103T00000X
- 523 - 103TC2200X
- 543 - 103TC0700X
- 669 - 103TA0400X
- 670 - 103TA0700X
- 671 - 103TB0200X
- 672 - 103TC1900X
- 674 - 103TF0000X
- 675 - 103TF0200X
- 676 - 103TP2701X
- 677 - 103TH0004X
- 678 - 103TH0100X
- 679 - 103TM1800X
- 681 - 103TR0400X
- 682 - 103TS0200X
- 074 - 103G00000X
Licensed Clinical Social Worker (LCSW)
- 191 - 1041C0700X
Licensed Master Social Worker (LMSW)
- 425 - 104100000X
Licensed Professional Clinical Counselor (LPCC)
- 190 - 101YP2500X
Licensed Professional Counselor (LPC)
- 194 - 101YP2500X
Licensed Marriage and Family Therapist (LMFT)
- 403 - 106H00000X

Community Paramedicine

Allowed ORP Provider Types and Specialties

Provider Type 020 - Physicians (Allopathic and Osteopathic)

Specialty/Taxonomy Codes – all

Provider Type 036 - Physician Assistants (PA) and Advanced Practice Registered Nurses (FNP, NP-C, CNS, CNM, CRNA)

Specialty/Taxonomy Codes – all

Diagnostic Services, Labs, and Imaging

Audiologic Function Tests;
Diagnostic and Screening Laboratory Services;
Diagnostic and Screening Radiology and Imaging Services;
Echocardiograms;
Electrocardiograms;
Electronic Analysis or Interrogation of implanted devices;
Neurodiagnostic Services (EEG, VEP, EMG, Polysomnography);
Pulmonary Function Studies / Testing; and
Psychological and Neuro-psychological Testing.

Allowed ORP Provider Types and Specialties

Provider Type 020 – Physicians (Allopathic and Osteopathic)

Specialty/Taxonomy Codes – all

Provider Type 036 - Physician Assistants (PA) and Advanced Practice Registered Nurses (FNP, NP-C, CNS, CNM, CRNA)

Specialty/Taxonomy Codes – all

Provider Type 010 – Behavioral Health & Social Services Providers

Psychologist Specialty/Taxonomy Codes
- 050 - 103T00000X
- 523 - 103TC2200X
- 543 - 103TC0700X
- 669 - 103TA0400X
- 670 - 103TA0700X
- 671 - 103TB0200X
- 672 - 103TC1900X
- 674 - 103TF0000X
- 675 - 103TF0200X
- 676 - 103TP2701X
- 677 - 103TH0004X
- 678 - 103TH0100X
- 679 - 103TM1800X
- 681 - 103TR0400X
- 682 - 103TS0200X

Provider Type 011 – Chiropractic Providers

Chiropractic Specialty and Taxonomy Codes
- 047 - 111N00000X
- 689 - 111NX0800X
- 690 - 111NP0017X
- 692 - 111NR0400X
- 064 - 1223X0400X
- 065 - 1223P0300X
- 066 - 1223P0700X
- 212 - 1223S0112X
- 515 - 1223X0400X

Provider Type 013 – Dietary & Nutritional Service Providers

Licensed Registered Dietitians (labs only)
- 056 - 133V00000X

Provider Type 018 – Pharmacy Service Providers (CLIA-waived lab tests only)

Pharmacist Specialty and Taxonomy Codes
- 253 - 183500000X
- 658 - 1835P2201X
- 791 - 1835G0303X
- 792 - 1835N0905X
- 793 - 1835N1003X
- 794 - 1835X0200X
- 796 - 1835P1200X
- 797 - 1835P1300X

Provider Type 021 – Podiatric Medicine and Surgery Providers

Podiatrist Specialty and Taxonomy Codes
- 120 - 213E00000X
- 903 - 213EP1101X
- 933 - 2251E1300X
- 504 - 213ES0131X
- 541 - 213ES0103X

Provider Type 022 - Physical Therapists – musculoskeletal plain films only

Physical Therapy Specialty and Taxonomy Codes
- 123 - 225100000X
- 932 - 2251C2600X
- 933 - 2251E1300X
- 934 - 2251E1300X
- 935 - 2251G0304X
- 936 - 2251G0304X
- 937 - 2251H1300X
- 938 - 2251N0400X
- 939 - 2251X0800X
- 940 - 2251P0200X
- 941 - 2251S0007X

Provider Type 012 – Dental Providers

Dental Specialty and Taxonomy Codes
- 001 - 1223G0001X
- 019 - 122300000X
- 062 - 1223E0200X
- 063 - 1223P0221X
- 064 - 1223X0400X
- 065 - 1223P0300X
- 066 - 1223P0700X
- 212 - 1223S0112X
- 515 - 1223X0400X

Durable Medical Equipment (DME), Supplies, and Prescription Drugs

Prescription drugs;
Durable Medical Equipment;
Eyeglass frames, lenses, and contacts;
Hearing aids;
Prosthetics; ND
Supplies.

Allowed ORP Tyes Specialties

Provider Type 020 - Physicians (Allopathic and Osteopathic)

Specialty/Taxonomy Codes – all

Provider type 036 - Physician Assistants (PA) and Advanced Practice Registered Nurses

Specialty/Taxonomy Codes – all

Provider Type 018 – Pharmacy Service Providers (prescription drugs & supplies only)

Pharmacist Specialty and Taxonomy Codes
- 253 - 183500000X
- 658 - 1835P2201X
- 791 - 1835G0303X
- 792 - 1835N0905X
- 793 - 1835N1003X
- 794 - 1835X0200X
- 796 - 1835P1200X
- 797 - 1835P1300X

Provider Type 021 – Podiatric Medicine and Surgery Providers

Podiatrist Specialty and Taxonomy Codes
- 120 - 213E00000X
- 903 - 213EP1101X
- 933 - 2251E1300X
- 504 - 213ES0131X
- 541 - 213ES0103X

Provider Type 022 – Respiratory, Developmental, Rehabilitative Service Providers

Occupational Therapy Specialty and Taxonomy Codes
- 126 - 225X00000X
- 216 - 225XE1200X
- 915 - 225XR0403X
- 916 - 225XE0001X
- 917 - 225XF0002X
- 918 - 225XG0600X
- 919 - 225XH1200X
- 920 - 225XH1300X
- 921 - 225XL0004X
- 922 - 225XM0800X
- 923 - 225XN1300X
- 924 - 225XP0200X
- 925 - 225XP0019X
Physical Therapy Specialty and Taxonomy Codes
- 123 - 225100000X
- 932 - 2251C2600X
- 933 - 2251E1300X
- 934 - 2251E1300X
- 935 - 2251G0304X
- 936 - 2251G0304X
- 937 - 2251H1300X
- 938 - 2251N0400X
- 939 - 2251X0800X
- 940 - 2251P0200X941 - 2251S0007X

Provider Type 015 - Eye and Vision Service Providers

Optometrist Specialty and Taxonomy Codes
- 088 – 152W00000X
- 617 – 152WC0802X
- 706 – 152WL0500X
- 707 – 152WX0102X
- 708 – 152WP0200X
- 709 – 2251G0304X
- 937 – 2251H1300X
- 938 – 2251N0400X
- 939 – 2251X0800X
- 940 – 2251P0200X
- 941 – 2251S0007X

Provider Type 023 – Language and Hearing Service Providers

Audiologist
- 087 - 231H00000X

Occupational Therapy

Evaluations
Treatment and Modalities

Allowed ORP Provider Types and Specialties

Provider Type 020 - Physicians (Allopathic and Osteopathic)

Specialty and Taxonomy – all

Provider type 036 - Physician Assistants (PA) and Advanced Practice Registered Nurses

Specialty and Taxonomy – all

Physical Therapy

Evaluations
Treatment and Modalities

Allowed ORP Provider Types Specialties

Provider Type 020 - Physicians (Allopathic and Osteopathic)

Specialty and Taxonomy – all

Provider Type 021 – Podiatric Medicine and Surgery Providers

Podiatrist Specialty and Taxonomy Codes
- 120 - 213E00000X
- 903 - 213EP1101X
- 933 - 2251E1300X
- 504 - 213ES0131X
- 541 - 213ES0103X

Provider type 036 - Physician Assistants (PA) and Advanced Practice Registered Nurses

Specialties – all

Preventive Services

Immunizations
Preventive Evaluation and Management Services
- Well-Child visits
- Adult preventive exams
Counseling for Risk Factor Reduction
- Tobacco Cessation

Allowed ORP Provider Types and Specialties

Provider Type 020 - Physicians (Allopathic and Osteopathic)

Specialty and Taxonomy – all

Provider Type 036 - Physician Assistants (PA) and Advanced Practice Registered Nurses

Specialty and Taxonomy – all

Provider Type 018 – Pharmacy Service Providers

Pharmacist Specialty and Taxonomy Codes
- 253 - 183500000X
- 658 - 1835P2201X
- 791 - 1835G0303X
- 792 - 1835N0905X
- 793 - 1835N1003X
- 794 - 1835X0200X
- 796 - 1835P1200X
- 797 - 1835P1300X

Local public health units may list their medical director or the provider who oversees their standing orders on the claim. ORP providers must be enrolled with ND Medicaid.

School-Based Services

Individualized Education Plan (IEP) Services

Occupational Therapy
Private Duty Nursing
Physical Therapy
Speech Therapy

For school-based Individualized Education Program (IEP) services, while a student’s IEP may serve as the prescription or referral, an enrolled provider with the authority to order the specified services must be identified as the ordering/referring provider (ORP) using their NPI on the claims submitted to Medicaid for those services consistent with 42 CFR § 455.410 and 455.440. The enrolled provider may be a member of the student’s IEP team.

Allowed ORP Provider Types and Specialties

Provider Type 020 - Physicians (Allopathic and Osteopathic)

Specialty and Taxonomy – all

Provider Type 036 - Physician Assistants (PA) and Advanced Practice Registered Nurses

Specialties – all

Provider Type 022 – Respiratory, Developmental, Rehabilitative Service Providers

Occupational Therapy Specialty and Taxonomy Codes
- 126 - 225X00000X
- 216 - 225XE1200X
- 915 - 225XR0403X
- 916 - 225XE0001X
- 917 - 225XF0002X
- 918 - 225XG0600X
- 919 - 225XH1200X
- 920 - 225XH1300X
- 921 - 225XL0004X
- 922 - 225XM0800X
- 923 - 225XN1300X
- 924 - 225XP0200X
- 925 - 225XP0019X
Physical Therapy Specialty and Taxonomy Codes
- 123 - 225100000X
- 932 - 2251C2600X
- 933 - 2251E1300X
- 934 - 2251E1300X
- 935 - 2251G0304X
- 936 - 2251G0304X
- 937 - 2251H1300X
- 938 - 2251N0400X
- 939 - 2251X0800X
- 940 - 2251P0200X
- 941 - 2251S0007X

Provider Type 023 – Language and Hearting Service Providers

Audiologist
- 087 - 231H00000X

Speech Language Pathologist

272 - 235Z00000X

Speech Therapy

Evaluations
Treatment and Modalities

Allowed ORP Provider Types and Specialties

Provider Type 020 - Physicians (Allopathic and Osteopathic)

Specialty and Taxonomy – all

Provider type 036 - Physician Assistants (PA) and Advanced Practice Registered Nurses

Specialties – all

Provider Type 012 – Dental Providers

Dental Specialty and Taxonomy Codes (based on the scope of practice extending to the whole oral cavity - swallowing difficulties/disorders)
- 001 - 1223G0001X
- 019 - 122300000X
- 062 - 1223E0200X
- 063 - 1223P0221X
- 064 - 1223X0400X
- 065 - 1223P0300X
- 066 - 1223P0700X
- 212 - 1223S0112X
- 515 - 1223X0400X

Reimbursement Methodology and Claim Instructions

Timely Filing

ND Medicaid must receive an original Medicaid primary claim within one hundred eighty (180) days from the date of service. The time limit may be waived or extended by ND Medicaid in certain circumstances. The Timely Filing Policy contains additional information.

Third-Party Liability

Medicaid members may have one or more additional source of coverage for health services. ND Medicaid is generally the payer of last resort. Providers must pursue the availability of third-party payment sources. The Third Party Liability Policy contains additional information.

Client Share (Recipient Liability)

Client share (recipient liability) is the monthly amount a member must pay toward the cost of medical services before the Medicaid program will pay for services received. The Client Share Policy contains additional information.

Reimbursement

A claim for services must be submitted at the provider’s usual and customary charge. Payment for services is limited to the lesser of the provider’s usual and customary charge or the ND Medicaid calculated reimbursement. ORP provider information must be submitted at the claim line level.

For electronic claims, reference the table below and the North Dakota MMIS Companion Guide 837p.

Loop ID	Reference	Name	Codes	Notes
2420E	NM1	Ordering Provider Name		This loop and segment are required for the services listed above.
2420E	NM109	Identification Code		Enter the Ordering Provider's NPI.
2420E	REF	Ordering Provider Secondary Identification		This loop and segment is highly recommended to include if the ND Medicaid ID is available.
2420E	REF01	Reference Identification Qualifier	G2
2420E	REF02	Reference Identification		Entering Ordering Provider's Medicaid ID.
2420F	NM1	Referring Provider Name		This loop and segment are required for the services listed above.
2420F	NM101	Entity Identifier Code	DN
2420F	NM109	Identification Code		Enter the referring Providers NPI
2420F	REF	Ordering Provider Secondary Identification		This loop and segment is highly recommended to include if the ND Medicaid ID is available.
2420F	REF01	Reference Identification Qualifier	G2
2420F	REF02	Reference Identification		Enter Referring Provider's ND Medicaid ID.

For web portal claims, instructions for submitting claims that include an ORP provider are on page 15 of ND MMIS Web Portal Professional Claim Form Submission Instructions.

For paper claims, Box 17 is the name of the ORP provider; 17b is the NPI of the ORP provider. A qualifier is required in box 17 to identify if the provider is the referring or ordering. Qualifier DN is used for referring; DK is used for ordering.

References

Related Policies

Provider Enrollment

Frequently Asked Questions

Question (Q): How do I know if a CPT® or HCPCS code requires an ORP?
Answer (A): Code-specific ORP requirements can be found on the Procedure Code Look-up Tool.

Q: What steps should ORP providers take if they are not yet enrolled with ND Medicaid?
A: Provider enrollment information and forms are located on the Provider Enrollment webpage. If you need assistance with provider enrollment, reach out to NDMedicaidEnrollment@noridian.com or (701) 277-6999.

Q: Can a provider be listed as the ORP provider when they are also listed as the rendering provider?
A: Yes, in some situations. If the rendering provider is also the ORP provider, they must be listed in both places on the claim. In all cases, providers must follow the scope of practice for their licensure and only provide allowable orders, referrals, or prescriptions.

Example: pediatrician is listed as both the ORP and rendering provider for a well-child visit.
Example: Clinic-based providers ordering labs or x-rays where the technical portion of the x-ray or lab will be billed under the ORP provider’s NPI.
Example: Psychological testing if the diagnostic interview determines that testing is needed.

Q: Can services be voice ordered / telephone ordered?
A: Yes, voice orders or telephone orders are acceptable but must be followed up with a written order.

Contact

Medical Services Call Center
Phone: (701) 328-7098
Toll-Free: (877) 328-7098
Email: mmisinfo@nd.gov

Policy Updates

September 2025

Behavioral Health Rehabilitative Services
- Clarified that Behavioral Analysts (BA), Behavior Modification Specialists (BMS), Licensed Bachelor Social Workers (LBSW), and Licensed Associate Professional Counselors (LAPC) can only be listed as the ORP for
  - Screening, Triage, and Referral Leading to Assessment
  - Crisis Intervention
  - Assessment for Alleged Abuse and/or Neglect and Recommended Plan of Care (formerly known as Forensic Interview)

October 2025

Community Health Workers
- Provider types and taxonomies added.
Community Paramedicine
- Provider types and taxonomies added.

April 2026

Formatting changes made throughout. CHW ordering referring updated to include LMSWs.

July 2026

ADA updates made throughout the policy.
Pharmacists added as CHWs for CLIA waived lab tests & prescription drugs.