Page 153 - Medicare Benefit Policy Manual

• Performed by a person who meets the definition of a CSW (See subsection A.);
and

• Not otherwise excluded from coverage.

A/B MACs (B) should become familiar with the State law or regulatory mechanism
governing a CSW’s scope of practice in their service area.

D. Noncovered Services

Services of a CSW are not covered when furnished to inpatients of a hospital or to
inpatients of a SNF if the services furnished in the SNF are those that the SNF is required
to furnish as a condition of participation in Medicare. In addition, CSW services are not
covered if they are otherwise excluded from Medicare coverage even though a CSW is
authorized by State law to perform them. For example, the Medicare law excludes from
coverage services that are not “reasonable and necessary for the diagnosis or treatment of
an illness or injury or to improve the functioning of a malformed body member.”

E. Outpatient Mental Health Services Limitation

All covered therapeutic services furnished by qualified CSWs are subject to the
outpatient psychiatric services limitation in Pub 100-01, Medicare General Information,
Eligibility, and Entitlement Manual, Chapter 3, “Deductibles, Coinsurance Amounts, and
Payment Limitations,” §30, (i.e., only 62 1/2 percent of expenses for these services are
considered incurred expenses for Medicare purposes). The limitation does not apply to
diagnostic services.

F. Assignment Requirement

Assignment is required.

180 - Nurse-Midwife (CNM) Services
(Rev. 10639; Issued: 03-12-2021; Effective: 01-01-2021; Implementation: 04-12-
2021)

A. General

Effective on or after July 1, 1988, the services provided by a certified nurse-midwife or
incident to the certified nurse-midwife’s services are covered. Payment is made under
assignment only.

See the Medicare Claims Processing Manual, Chapter 12, “Physician and Nonphysician
Practitioners,” §130, for payment methodology for nurse midwife services.

B. Certified Nurse-Midwife Defined