Page 160 - Medicare Benefit Policy Manual

• 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.

The NPs applying for a Medicare billing number for the first time on or after January 1,
2003, must meet the requirements 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;

• Be certified as a nurse practitioner by a recognized national certifying body
that has established standards for nurse practitioners; and

• Possess a master’s degree in nursing or a doctor of nursing practice (DNP)
doctoral degree.

B. Covered Services

Coverage is limited to the services an NP is legally authorized to perform in accordance
with State law (or State regulatory mechanism established by State law).

1. General

The services of an NP may be covered under Part B if all of the following conditions are
met:
• They are the type that are considered physician’s services if furnished by a
doctor of medicine or osteopathy (MD/DO);

• They are performed by a person who meets the definition of an NP (see
subsection A);

• The NP is legally authorized to perform the services in the State in which they
are performed;

• They are performed in collaboration with an MD/DO (see subsection D); and

• They are not otherwise precluded from coverage because of one of the
statutory exclusions. (See subsection C.2.)

2. Incident To