Page 162 - Medicare Benefit Policy Manual

D. Collaboration

Collaboration is a process in which an NP works with one or more physicians (MD/DO)
to deliver health care services, with medical direction and appropriate supervision as
required by the law of the State in which the services are furnished. In the absence of
State law governing collaboration, collaboration is to be evidenced by NPs documenting
their scope of practice and indicating the relationships that they have with physicians to
deal with issues outside their scope of practice.

The collaborating physician does not need to be present with the NP when the services
are furnished or to make an independent evaluation of each patient who is seen by the
NP.

E. Direct Billing and Payment

Direct billing and payment for NP services may be made to the NP.

F. Assignment

Assignment is mandatory.

210 - Clinical Nurse Specialist (CNS) 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 clinical nurse specialist (CNS) 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 CNS services in the State where
the services are performed. CNSs who were issued billing provider numbers prior to
January 1, 1998, may continue to furnish services under the CNS benefit.

Payment for CNS 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 CNSs

In order to furnish covered CNS services, a CNS must meet the conditions as follows:

1. Be a registered nurse who is currently licensed to practice in the State where he or
she practices and be authorized to furnish the services of a clinical nurse specialist
in accordance with State law;

2. Have a master’s degree in a defined clinical area of nursing from an accredited
educational institution or a doctor of nursing practice (DNP) doctoral degree; and