Cal. Code Regs. Tit. 22, § 51503.1 - Reimbursement for Services Rendered by a Nonphysician Medical Practitioner
(a) Except as
provided in (b), reimbursement for services rendered by a nonphysician medical
practitioner shall be made directly to the physician, organized outpatient
clinic or hospital outpatient department utilizing the nonphysician medical
practitioner.
(b) Reimbursement for
services rendered by a nurse midwife, a certified family nurse practitioner, or
a certified pediatric nurse practitioner shall be made in accordance with
Section 51503.2.
(c) Reimbursement shall be the lesser of the
billed amount or the rates established pursuant to Section
51503.
(d) All claims for payment for nonphysician
medical practitioner services rendered pursuant to (a) shall include:
(1) The name and license or certificate
number of the nonphysician medical practitioner rendering the
service.
(2) The location at which
the service was rendered.
(3) The
name of the supervising physician or the attending
physician.
(e)
Reimbursement for services rendered by nonphysician medical practitioners shall
be limited to those which are:
(1) Defined by
statutes and regulations as Medi-Cal reimbursable services.
(2) Within the scope of services permitted by
the statutes and regulations governing the activities of licensed physician's
assistants, nurse midwives, and nurse practitioners.
(3) Within the scope of the
Physician-Practitioner Interface as defined in Section
51171.
Notes
2. Certificate of Compliance filed 8-9-78 (Register 78, No. 31).
3. Amendment filed 8-13-86; effective upon filing (Register 86, No. 33).
4. Amendment of section and NOTE filed 5-3-93 as an emergency; operative 5-3-93 (Register 93, No. 19). A Certificate of Compliance must be transmitted to OAL 8-31-93 or emergency language will be repealed by operation of law on the following day.
5. Reinstatement of section as it existed prior to emergency amendment filed 5-3-93 by operation of Government Code section 11346.1(f) (Register 93, No. 44).
6. Amendment of section and NOTE refiled 10-27-93 as an emergency; operative 10-27-93 (Register 93, No. 44). A Certificate of Compliance must be transmitted to OAL by 2-25-94 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 10-27-93 order including amendment of NOTE transmitted to OAL 10-18-93 and filed 12-2-93 (Register 93, No. 49).
Note: Authority cited: Sections 14053, 14105, 14124.5, 14132 and 14132.41, Welfare and Institutions Code. Reference: Articles 2 and 2.5 of Chapter 6, and Chapter 7.7, Business and Professions Code; and Sections 14115.6 and 14132.41, Welfare and Institutions Code.
2. Certificate of Compliance filed 8-9-78 (Register 78, No. 31).
3. Amendment filed 8-13-86; effective upon filing (Register 86, No. 33).
4. Amendment of section and Note filed 5-3-93 as an emergency; operative 5-3-93 (Register 93, No. 19). A Certificate of Compliance must be transmitted to OAL 8-31-93 or emergency language will be repealed by operation of law on the following day.
5. Reinstatement of section as it existed prior to emergency amendment filed 5-3-93 by operation of Government Code section 11346.1(f) (Register 93, No. 44).
6. Amendment of section and Note refiled 10-27-93 as an emergency; operative 10-27-93 (Register 93, No. 44). A Certificate of Compliance must be transmitted to OAL by 2-25-94 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 10-27-93 order including amendment of Note transmitted to OAL 10-18-93 and filed 12-2-93 (Register 93, No. 49).
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