Nurse Practitioners

10.2.3.8 – Nurse Practitioners (Rev. 11771; Issued: 12-30-2022; Effective:01-01-2023; Implementation: 01-31-23) Federal regulations at 42 CFR § 410.75(b) state that 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. The individual must also meet one of the following criteria: 1. Obtained Medicare billing privileges as a nurse practitioner for the first time on or after January 1, 2003, and meets the following requirements: a. Is certified as a nurse practitioner by a recognized national certifying body that has established standards for nurse practitioners. b. Possesses a master’s degree in nursing or a Doctor of Nursing Practice (DNP) doctoral degree. (If the aforementioned master’s or doctoral degree is required to obtain a license as a nurse practitioner in the state, the contractor need not separately verify the degree or require the practitioner to submit applicable documentation.) 2. Obtained Medicare billing privileges as a nurse practitioner for the first time before January 1, 2003, and meets the standards in (1)(a) above. 3. Obtained Medicare billing privileges as a nurse practitioner for the first time before January 1, 2001. Pub. 100-02, chapter 15, section 200 lists the following organizations as CMS-recognized national certifying bodies for nurse practitioners at the advanced practice level: • American Academy of Nurse Practitioners • American Nurses Credentialing Center • National Certification Corporation for Obstetric, Gynecologic and Neonatal Nursing Specialties • Pediatric Nursing Certification Board (previously named the National Certification Board of Pediatric Nurse Practitioners and Nurses) • Oncology Nurses Certification Corporation • AACN Certification Corporation • National Board on Certification of Hospice and Palliative Nurses • Nurses Portfolio Credentialing Commission (NPCC)