Page 156 - Medicare Benefit Policy Manual

See §60.2 for coverage of services performed by nurse-midwives incident to the service
of physicians.

F. Place of Service

There is no restriction on place of service. Therefore, nurse-midwife services are covered
if provided in the nurse-midwife’s office, in the patient’s home, or in a hospital or other
facility, such as a clinic or birthing center owned or operated by a nurse-midwife.

G. Assignment Requirement

Assignment is required.

190 - Physician Assistant (PA) Services
(Rev. 11288; Issued: 03-04-22; Effective: 01-01-22; Implementation: 02-15-22)

Effective for services rendered on or after January 1, 1998, any individual who is
participating under the Medicare program as a physician assistant for the first time may
have his or her professional services covered if he or she meets the qualifications listed
below and he or she is legally authorized to furnish PA services in the State where the
services are performed. PAs who were issued billing provider numbers prior to
January 1, 1998 may continue to furnish services under the PA benefit.

See the Medicare Claims Processing Manual, Chapter 12, “Physician and Nonphysician
Practitioners,” §110, for payment methodology for PA services. Payment is made under
assignment only.

A. Qualifications for PAs

To furnish covered PA services, the PA must meet the conditions as follows:

1. Have graduated from a physician assistant educational program that is accredited
by the Accreditation Review Commission on Education for the Physician Assistant
(its predecessor agencies, the Commission on Accreditation of Allied Health
Education Programs (CAAHEP) and the Committee on Allied Health Education and
Accreditation (CAHEA); or

2. Have passed the national certification examination that is administered by the
National Commission on Certification of Physician Assistants (NCCPA); and

3. Be licensed by the State to practice as a physician assistant.

B. Covered Services

Coverage is limited to the services a PA is legally authorized to perform in accordance
with State law (or State regulatory mechanism provided by State law).