Page 164 - Medicare Benefit Policy Manual

State law or regulations governing a CNS’ scope of practice in the State in which the
services are furnished applies. A/B MACs (B) must develop a list of covered services
based on the State scope of practice.

Examples of the types of services that a CNS may furnish include services that
traditionally have been reserved for 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 his or her State license, a CNS may furnish services billed
under all levels of evaluation and management codes and diagnostic tests if furnished in
collaboration with a physician.

3. Incident To

If covered CNS services are furnished, services and supplies furnished incident to the
services of the CNS may also be covered if they would have been covered when
furnished incident to the services of an MD/DO as described in §60.

4. 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 Clinical
Nurse Specialist (CNS) covered services, the CNS 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 CNS’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 CNS Services

Examples of the types of services that CNS may provide are services that traditionally
have been reserved for 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. State law or regulation
governing a CNS’ scope of practice for his or her service area applies.

2. Services Otherwise Excluded From Coverage