From January 1, 2028 payment requires a separate provider number
Making further consolidated appropriations for the fiscal year ending September 30, 2026, and for other purposes, section 6225, Sec. 6225.
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From January 1, 2028 payment requires a separate provider number
The document says “may not”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 6225 in the PDF
What the document says
“such department has obtained, and such items and services are billed under, a National Provider Identifier that is separate from such identifier for such provider;”
Section 6225 adds a new paragraph (23) to section 1833(t) of the Social Security Act. No payment may be made for items and services furnished on or after January 1, 2028 by an off-campus outpatient department of a provider unless the department has its own National Provider Identifier, separate from the provider's, and bills under it.
What the document actually says
“such department has obtained, and such items and services are billed under, a National Provider Identifier that is separate from such identifier for such provider;”
That sentence, in plain words
The site must get its own provider number. The bills for its care must go out under that number. The number is not the same as the parent one.
What this is about
A hospital can own clinics far from its main campus. Billing them all under one number hides where care was given. A separate number makes the site visible.
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Consolidated Appropriations Act, 2026, Public Law 119-75, sec. 6225, 140 Stat. 682 (2026). https://www.govinfo.gov/content/pkg/PLAW-119publ75/html/PLAW-119publ75.htm
This page
“From January 1, 2028 payment requires a separate provider number,” Consolidated Appropriations Act, 2026, section 6225, Sec. 6225. Read the Mandate, https://readthemandate.org/consolidated-appropriations-act-2026/proposal/sec6225-separate-npi-required/ (retrieved August 26, 2026).
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