Page 165 - Medicare Benefit Policy Manual

A CNS’ services are not covered if they are otherwise excluded from coverage even
though a CNS may be authorized by State law to perform them. For example, the
Medicare law excludes from coverage routine foot care and routine physical checkups
and services that are not reasonable and necessary for diagnosis or treatment of an illness
or injury or to improve the function of a malformed body member. Therefore, these
services are precluded from coverage even though they may be within a CNS’ scope of
practice under State law.

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

D. Collaboration

Collaboration is a process in which a CNS works with one or more physicians (MD/DO)
to deliver health care services within the scope of the CNS’ professional expertise 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 the CNS documenting his or her scope of practice and
indicating the relationships that the CNS has with physicians to deal with issues outside
the CNS’ scope of practice.

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

E. Direct Billing and Payment

A CNS may bill directly and receive direct payment for their services.

F. Assignment Requirement

Assignment is required for the service to be covered.

220 - Coverage of Outpatient Rehabilitation Therapy Services (Physical
Therapy, Occupational Therapy, and Speech-Language Pathology
Services) Under Medical Insurance
(Rev.255, Issued: 01-25-19, Effective: 01- 01- 19, Implementation: 02-26-19)

A comprehensive knowledge of the policies that apply to therapy services cannot be
obtained through manuals alone. The most definitive policies are Local Coverage
Determinations found at the Medicare Coverage Database www.cms.hhs.gov/mcd. A list
of Medicare contractors is found at the CMS Web site. Specific questions about all
Medicare policies should be addressed to the contractors through the contact information
supplied on their Web sites. General Medicare questions may be addressed to the
Medicare regional offices http://www.cms.hhs.gov/RegionalOffices/.