Page 159 - Medicare Benefit Policy Manual
P. 159
200 - Nurse Practitioner (NP) Services
(Rev. 11771 ; Issued:12-30-22 ; Effective:01-01-23 ; Implementation:01-01-23 )
Effective for services rendered after January 1, 1998, any individual who is participating
under the Medicare program as a nurse practitioner (NP) for the first time ever, 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 NP services in the State where the services
are performed. NPs who were issued billing provider numbers prior to January 1, 1998,
may continue to furnish services under the NP benefit.
Payment for NP services is effective on the date of service, that is, on or after January 1,
1998, and payment is made on an assignment-related basis only.
A. Qualifications for NPs
In order to furnish covered NP services, an NP must meet the conditions as follows:
• Be a registered professional nurse who is authorized by the State in which the
services are furnished to practice as a nurse practitioner in accordance with
State law; and be certified as a nurse practitioner by a recognized national
certifying body that has established standards for nurse practitioners; or
• Be a registered professional nurse who is authorized by the State in which the
services are furnished to practice as a nurse practitioner by December 31,
2000.
The following organizations are recognized national certifying bodies for NPs at the
advanced practice level:
• American Academy of Nurse Practitioners;
• American Nurses Credentialing Center;
• National Certification Corporation for Obstetric, Gynecologic and Neonatal
Nursing Specialties;
• Pediatric Nursing Certification Board (previously named the National
Certification Board of Pediatric Nurse Practitioners and Nurses);
• Oncology Nurses Certification Corporation;
• AACN Certification Corporation;
• National Board on Certification of Hospice and Palliative Nurses; and,
• Nurse Portfolio Credentialing Commission.
The NPs applying for a Medicare billing number for the first time on or after January 1,
2001, must meet the requirements as follows:
