Page 155 - Medicare Benefit Policy Manual

are furnished and that would otherwise be covered if furnished by a physician, including
obstetrical and gynecological services.

2. Incident To - Services and supplies furnished incident to a nurse midwife’s service
are covered if they would have been covered when furnished incident to the services of a
doctor of medicine or osteopathy, as described in §60.

3. Medical Record Documentation for Part B Services –This medical record
documentation requirement applies to Part B professional services that are paid under the
Medicare physician fee schedule. Accordingly, for Part B certified nurse-midwives
covered services, the certified nurse-midwife may review and verify (sign and date),
rather than re-document notes in a patient’s medical record made by physicians,
residents, nurses, medical; physician assistant; nurse practitioner; clinical nurse specialist;
certified nurse-midwife; and certified registered nurse anesthetist students or other
members of the medical team, including as applicable, notes documenting the certified
nurse-midwives presence and participation in the service.

For documentation requirements specific to E/M services furnished by physicians and
certain nonphysician practitioners, see Chapter 12, section 30.6 of the Medicare Claims
Processing Manual, publication 100-04.

D. Noncovered Services

The services of nurse-midwives are not covered if they are otherwise excluded from
Medicare coverage even though a nurse-midwife is authorized by State law to perform
them. For example, the Medicare program excludes from coverage routine physical
checkups and 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.

Coverage of service to the newborn continues only to the point that the newborn is or
would normally be treated medically as a separate individual. Items and services
furnished the newborn from that point are not covered on the basis of the mother’s
eligibility.

E. Relationship With Physician

Most States have licensure and other requirements applicable to nurse-midwives. For
example, some require that the nurse-midwife have an arrangement with a physician for
the referral of the patient in the event a problem develops that requires medical attention.
Others may require that the nurse-midwife function under the general supervision of a
physician. Although these and similar State requirements must be met in order for the
nurse-midwife to provide Medicare covered care, they have no effect on the nurse-
midwife’s right to personally bill for and receive direct Medicare payment. That is,
billing does not have to flow through a physician or facility.