Page 163 - Medicare Benefit Policy Manual

3. Be certified as a clinical nurse specialist by a recognized national certifying body
that has established standards for CNSs.

The following organizations are recognized national certifying bodies for CNSs 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.

B. Covered Services

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

1. General

The services of a CNS may be covered under Part B if all of the following conditions are
met:

• They are the types of services that are considered as physician’s services if
furnished by an MD/DO;

• They are furnished by a person who meets the CNS qualifications (see
subsection A);

• The CNS is legally authorized to furnish the services in the State in which
they are performed;

• They are furnished in collaboration with an MD/DO as required by State law
(see subsection C); and

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

2. Types of CNS Services that May be Covered