Title XVIII of the Social Security Act, §1861(s)(2)(K) addresses services which would be physicians' services if furnished by a physician and which are performed by a physician assistant, nurse practitioner or clinical nurse specialist.
Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations.
Title XVIII of the Social Security Act, §1862(a)(14) excludes payment for services, which are other than physicians’ services, certified nurse-midwife services, qualified psychologist services, and services of a certified registered nurse anesthetist, and which are furnished to an individual who is a patient of a hospital or critical access hospital by an entity other than the hospital or critical access hospital, unless the services are furnished under arrangements with the entity made by the hospital or critical access hospital.
42 Code of Federal Regulations (CFR) §410.74 Physician assistants' services
42 Code of Federal Regulations (CFR) §410.75 Nurse practitioners' services
42 Code of Federal Regulations (CFR) §410.76 Clinical nurse specialists' services
42 Code of Federal Regulations (CFR) §419.22 Hospital services excluded from payment under the hospital outpatient prospective payment system
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