Medicare Part B Health Professionals – Education/Credentialing



Medicare Part B Health Professionals – Education/Credentialing

Health Care Professional |

BA |

Master’s |

Ph.D. |

Other

Credentialing |Social

Security Act |Physician

Supervision |Direct

Billing |42 CFR | |Physical Therapist | | | |yes[i] |§1861(p) |[ii], | |§484.4

§410.60 | |Physical Therapist in Independent Practice | | | |yes1 |§1861(p), 2d sentence |2 |√ |§410.60(c) | |Occupational Therapist | | | |yes[iii] |§1861(g) §1861(h) | |√ [iv] | §484.4

§410.59 | |Speech-Language Pathologist | |

√, or |

√ | yes[v], [vi] |§1861(ll)(3)(A) |2 | | §484.4 §410.62 | |Audiologist | |√, or |√ | yes 6, 7 |§1861(ll)(3)(B)

§1835(a)(2)(D) |2 | |§484.4 | |Physician Assistant | |

| |yes[vii] |§1861(aa)(5)(A) |General supervision |[viii] |§410.74 | |Nurse Practitioner | |

√ [ix] | |yes[x] |§1861(aa)(5)(A)[xi] |Collaboration |√ [xii] |§410.75(b)

§424.11(e)(5) | |Clinical Nurse Specialist | |

√ | | |§1861(aa)(5)(B)

§1833(a)(1)(O) |Collaboration |√ |§410.150(b)(16) | |Nurse-Midwife | | |

|

yes[xiii]

|§1861(gg)

§1833(a)(1)(K)

§1861(s)(2)(L) |No (unless required by State law) |√ |§410.77(a) §414.54 | |Qualified Psychologist | | |√ | |§1861(ii)

§1861(s)(2)(M) |No | √ |§410.71(d)

§410.150(b)(17) | |Clinical Social Worker | |

√, or |

√ |yes[xiv] |§1861(hh)

§1861(s)(2)(N)

§1833(a)(1)(F) |Agreement to consult[xv] |√ |§410.73(a)

§410.150(b)(18) | |Certified Registered Nurse Anesthetist | | | |yes[xvi] |§1861(bb)(2)

§1861(s)(11)

§1833(a)(1)(H) | | √ |§410.69 §419.2(c)(5) | |

-----------------------

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獉愠朠: Has graduated from a physical therapy curriculum approved by: (1) The American Physical Therapy Association; or (2) The Commission on Allied Health Education and Accreditation of the American Medical Association; or (3) The Council on Medical Education of the American Medical Association and the American Physical Therapy Association.

[ii] Patient must be under the care of a physician and under a plan of care approved by a physician.

[iii] 42 CFR 484.4: A person who: (a) Is a graduate of an occupational therapy curriculum accredited jointly by the Committee on Allied Health Education and Accreditation of the American Medical Association and the American Occupational Therapy Association; or (b) Is eligible for the National Registration Examination of the American Occupational therapy Association. . . .

[iv] Applies only to an occupational therapist in independent practice. See 42 CFR 410.59(c)(iii).

[v] 42 CFR 484.4: (1) Meets the education and experience requirements for a Certificate of Clinical competence in Speech Pathology or Audiology granted by the Speech-Language Hearing Association; or (2) Meets the educational requirements for certification and is in the process of accumulating the supervised experience required for certification.

[vi] Sec. 1861(ll)(A)(ii), (B)(ii): In the absence of State licensure, 350 hours of supervised clinical practicum, plus 9 months of supervised full-time services after obtaining degree, plus national examination.

[vii] 42 CFR 410.74(c): (1) Is a graduate of an educational program accredited by the Commission on Accreditation of Allied Health Programs; or (2) Passed national certification examination of the National Commission on Certification of Physician Assistants.

[viii] 42 CFR 410.150(b)(15): Direct billing is limited to the employer of the physician assistant.

[ix] 42 CFR 410.75(b)(1)(ii): For those NPs first applying for a Medicare billing number beginning January 1, 2003.

[x] 42 CFR 410.75(b)(1)(ii): Be certified as a nurse practitioner by a recognized national certifying body that has established standards for nurse practitioners. . . .

[xi] Services of a nurse practitioner are covered in a Rural Health Clinic (405.2414), Hospice (418.304), Critical Access Hospital (485.604, 85.631, 413.70(b)(4)), Rural Health Clinic and Federally Qualified Health Clinic (491.8), and in furnishing prostate screening tests (410.39).

[xii] 42 CFR 410.150(b)(16).

[xiii] 42 CFR 410.77(a): (2) Have successfully completed a program of study and clinical experience for nurse-midwives that is accredited by an accrediting body approved by the U.S. Department of Education; (3) Be certified as a nurse-midwife by the American College of Nurse-Midwives or the American College of Nurse-Midwives Certification Council.

[xiv] 42 CFR 410.73(a): (2) After obtaining the degree, has performed at least 2 years of supervised clinical social work; and (3) Either is licensed or certified as a clinical social worker by the State in which the services are performed or, in the case of an individual in a State that does not provide for licensure or certification as a clinical social worker --(i) Is licensed or certified at the highest level of practice provided by the laws of the State in which the services are performed; and (ii) Has completed at least 2 years or 3,000 hours of post master's degree supervised clinical social work practice under the supervision of a master's degree level social worker in an appropriate setting such as a hospital, SNF, or clinic.

[xv] 42 CFR 410.73(c).

[xvi] 42 CFR 410.68(b): Has graduated from a nurse anesthesia educational program that meets the standards of the Council on Accreditation of Nurse Anesthesia Programs, or such other accreditation organization as may be designated by the Secretary; and Has passed a certification examination of the Council on Certification of Nurse Anesthetists, or any other certification organization that may be designated by the Secretary; etc.

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