Page 161 - Medicare Benefit Policy Manual

If covered NP services are furnished, services and supplies furnished incident to the
services of the NP may also be covered if they would have been covered when furnished
incident to the services of an MD/DO 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 nurse
practitioner covered services, the nurse practitioner 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 nurse
practitioner’s 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.

C. Application of Coverage Rules

1. Types of NP Services That May Be Covered

State law or regulation governing an NP’s scope of practice in the State in which the
services are performed applies. Consider developing a list of covered services based on
the State scope of practice. Examples of the types of services that NP’s may furnish
include services that traditionally have been reserved to physicians, such as physical
examinations, minor surgery, setting casts for simple fractures, interpreting x-rays, and
other activities that involve an independent evaluation or treatment of the patient’s
condition. Also, if authorized under the scope of their State license, NPs may furnish
services billed under all levels of evaluation and management codes and diagnostic tests
if furnished in collaboration with a physician.

See §60.2 for coverage of services performed by NPs incident to the services of
physicians.

2. Services Otherwise Excluded From Coverage

The NP services may not be covered if they are otherwise excluded from coverage even
though an NP may be authorized by State law to perform them. For example, the
Medicare law excludes from coverage routine foot care, 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. Therefore, these
services are precluded from coverage even though they may be within an NP’s scope of
practice under State law.