Audiologist

The following requirements must be met by an audiologist:

• Possess a masters or doctoral degree in audiology
• Licensed as an audiologist in the state in which services are performed, and
• Eligible for a certificate of clinical competence in audiology granted by the American Speech and Hearing Associations under its requirements

Certified nurse-midwife must:

The following requirements must be met by a certified nurse-midwife:

• Currently licensed as a registered professional nurse in the state in which services are performed, and
• Legally authorized under state law or regulations to practice as a nurse-midwife and have completed a program of study, and clinical experience for nurse-midwife as specified by the state

Coverage is available for services performed by a certified nurse midwife working in collaboration with a physician (i.e., a Doctor of Medicine [MD] or Doctor of Osteopathy [DO]). A resume (CV) may be submitted for documentation.

Clinical Nurse Specialist

Effective January 1, 1998, coverage is available for services performed by a clinical nurse specialist (CNS) in all areas, and payment is made on an assignment-related basis only.

Coverage is available for services performed by CNS working in collaboration with a physician (i.e., MD or DO).

Direct payment can be made to the CNS, the employer, or contractor of the CNS with the following qualifications:

• Licensed in the state in which the services are performed
• Possess a master’s degree in a defined clinical area of nursing from an accredited educational institution;
• Have a minimum of two years postgraduate direct patient care in the practice discipline of the private practice for which the nurse has been prepared
• Certified as a CNS by the American Nurses Credentialing Center

A resume (CV) may be submitted for documentation

Dietitian and Nutritionist

Beginning January 1, 2002, medical nutrition therapy (MNT) is a covered Medicare service when provided by a qualifying registered dietitian or nutrition professional. A dietitian or nutritionist must be licensed or certified by the state in which the services are performed as of December 21, 2000, or must be an individual who, on or after December 22, 2000, meets the following qualifications:

• Holds a bachelor’s or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the academic requirements of a program in nutrition or dietetics, as accredited by an appropriate national accreditation organization recognized for this purpose
• Completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional, and
• Licensed or certified as a dietitian or nutrition professional by the state in which the services are performed

A resume (CV) may be submitted for documentation

Nurse Practitioner

Note: Effective January 1, 1998, coverage is available for NP services in all areas and payment is made on an assignment-related basis only.

In order to furnish covered NP services, the NP must meet the following requirements:

• Registered as a professional nurse who is authorized by the state in which the services are furnished to practice as an NP in accordance with state law, and
• Certified as a nurse practitioner by a recognized national certifying body that has established standards for NPs

• American Academy of Nurse Practitioners
• American Nurse Credentialing Center
• Critical Care Certification Corporation
• National Certification Board of Pediatric Nurse Practitioners & Nurses
• National Certification Corporation for Obstetrics, Gynecologic, and Neonatal Nursing Specialties
• Oncology Nurses Certification Corporation

Clinical Social Worker

Effective September 1, 2004, the state of New York licenses social workers as clinical. Therefore, in order to enroll in Medicare and be paid as a clinical social worker, you must be licensed as licensed clinical social worker (LCSW).

Clinical Psychologist

A clinical psychologist must meet the following requirements:

• Currently licensed as a clinical psychologist in the state in which services are performed;
• Holds a doctoral degree in psychology from a program in clinical psychology

Physical or Occupational Therapist in Independent Practice

Coverage of outpatient physical therapy and occupational therapy under Part B includes the services of a qualified therapist in independent practice when furnished in the therapist’s office or the beneficiary’s home.

A qualified physical or occupational therapist, for program coverage purposes, is an individual who is licensed as a physical or occupational therapist by the state in which services are performed.

Physician Assistant

Effective for service rendered on or after January 1, 1998, any individual who is participating under the Medicare program as a physician assistant (PA) for the first time ever, may have his or her professional services covered if he or she meets the qualifications listed below and are legally authorized to furnish PA services in the state where their services are performed. Physician assistants who were issued billing provider numbers prior to January 1, 1998 may continue to furnish services under the PA benefit.

Payment for PA services is effective on the date of services, which is, on or after January 1, 1998, and payment is made on an assignment-related basis only.

To furnish covered PA services, the PA must meet the following requirements:

• Graduate of a physician assistant educational program that is accredited by the Accreditation Review Commission on Education for the Physician Assistant (its predecessor agencies, the Commission on Accreditation of Allied Health Education Programs (CAAHEP), and the Committee on Allied Health Education and Accreditation (CAHEA), or
• Passed the National Certification Examination that is administered by the National Commission on Certification of Physician Assistants (NCCPA), and
• Licensed by the state to practice as a physician assistant

Independent Diagnostic Treatment Facility (IDTF)

An independent diagnostic treatment facility (IDTF) must have one or more supervising physicians who are responsible for the direct and ongoing oversight of the quality of the testing performed, the proper operation, and calibration of the equipment used to perform tests, and the qualification of nonphysician personnel who use the equipment. This level of supervision equates to that required for general supervision.

The supervising physician must evidence proficiency in the performance and interpretation of each type of diagnostic procedure performed by the IDTF. Please refer to standards published in the 1999–2000 edition of the American College of Radiology (ACR) standards.

Submit resume (CV) and any certifications documenting qualifications.

Any nonphysician personnel used by the IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question, and have training proficiency as evidenced by licensure or certification by the appropriate state agency, or must be certified by the appropriate national credentialing body. Please refer to standards published in the 1999-2000 edition of the ACR.

Submit resume (CV) and any certifications documenting qualifications.

An IDTF that operates across state boundaries (i.e., multi-state entities) must maintain documentation that it’s supervising physicians and technicians are licensed and certified in each of the states in which it is furnishing services.

• Contact the state to determine whether you need Article 28 Certification (submit copies of correspondence with the state showing evidence of inquiry or determination)
• Submit a copy of your Incorporation papers
• Submit a copy of your state filing receipt
• Submit a copy of your Tax Certificate (IRS CP 575)