US · guidance
CMS SOM App. FC, Tag M0111
§485.904(b)(9) Advanced practice nurse
An individual who meets the following
qualifications:
(i) Is a nurse practitioner who meets the qualifications at §410.75 of this chapter; or
(ii) Is a clinical nurse specialist who meets the qualifications at §410.76 of this
chapter.
Interpretive Guidelines §485.904(b)(9)
Each nurse practitioner must meet all of the qualifications as stated from §410.75(b):
(b) Qualifications. For Medicare Part B coverage of his or her services, a nurse
practitioner must be a registered professional nurse who is authorized by the State in
which the services are furnished to practice as a nurse practitioner in accordance with
State law, and must meet one of the following:
(1) Obtained Medicare billing privileges as a nurse practitioner for the first
time on or after January 1, 2003, and meets the following requirements:
(i) Be certified as a nurse practitioner by a recognized national certifying body
that has established standards for nurse practitioners. (ii) Possess a master’s
degree in nursing or a Doctor of Nursing Practice (DNP) doctoral degree.
(2) Obtained Medicare billing privileges as a nurse practitioner for the first
time before January 1, 2003, and meets the standards in paragraph (b)(1)(i) of
this section.
(3) Obtained Medicare billing privileges as a nurse practitioner for the first
time before January 1, 2001.
Each clinical nurse specialist meets all of the qualifications as stated from §410.76(b):
(b) Qualifications. For Medicare Part B coverage of his or her services, a clinical
nurse specialist must—
(1) Be a registered nurse who is currently licensed to practice in the State
where he or she practices and be authorized to perform the services of a
clinical nurse specialist in accordance with State law;
(2) Have a master’s degree in a defined clinical area of nursing from an
accredited educational institution or a Doctor of Nursing Practice (DNP)
doctoral degree; and
(3) Be certified as a clinical nurse specialist by a national certifying body
that has established standards for clinical nurse specialists and that is
approved by the Secretary.
History
Rev. 196, Issued: 01-10-20, Effective: 01-10-20, Implementation: 01-10-20
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
141861ce9cffd499b13eff07ee30e5781a3970c6dc952d68908d2dcf9456d759
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