Payment rules relaxed for physician extenders
More nonphysician services will be covered
One controversial new change in Medicare payment rules removes current restrictions on the areas and settings in which nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants (PAs) can be paid directly off the physician fee schedule for performing diagnostic tests previously only provided by or under the supervision of a physician.
Many medical societies see this as another attempt to water down the Medicare fee schedule by expanding the number of reimbursable services that can be performed by nonphysician providers.
Under the new regulation, no physician supervision is required of NPs and CNSs performing X-rays and other diagnostic tests if they are already authorized by the state to conduct those tests. In addition, PAs authorized by state law to perform diagnostic tests now only need only a general level of physician supervision to be paid directly by Medicare.
Also included in the final rule are NPs and CNSs who perform state-authorized tests at independent diagnostic testing facilities (IDTF). For IDTF billing purposes, HCFA has instituted a retroactive March 15, 1999, implementation date.
There is an exception. The new rules do not apply to pathology or laboratory codes in the 80000 series of the CPT payable under the physician fee schedule because those codes already are covered by the Clinical Laboratory Improve ment Amendments (CLIA) regulations. As such, CLIA regulations should determine the level of supervision necessary, if any, for those procedures. (For a list of other changes in Medicare payment policies, see Physician’s Coding Strategist, p. 7.)
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