CAM 455

Registered Nurses Practicing in Extended Roles

Category:Other   Last Reviewed:May 2019
Department(s):Medical Affairs   Next Review:May 2020
Original Date:May 1993    

Description:
The "extended role" of a registered nurse means a collaborative process whereby a nurse with advanced education and training is recognized by the South Carolina Board of Nursing to perform additional patient care services.  This extended role includes performing delegated medical services independently, but under the general supervision of a licensed physician who is readily available for consultation.  This does not authorize violation of the Medical Practice Laws of South Carolina.  The role of a registered nurse functioning under these guidelines requires specialized knowledge, judgment and skill in assessment and management of physical and psychological health-illness status of the individuals and/or families and/or groups.

Examples of nurses performing in "extended roles" are: Family Nurse Practitioners, Pediatric Nurse Practitioners, Certified Psychiatric Nurses, Certified Registered Nurse Midwives and Certified Registered Nurse Anesthetists.  These nurses practicing in extended roles may practice in cooperation with or as part of an existing medical practice (group or solo practice).

Policy:
It is appropriate to recognize reimbursement for medically necessary services rendered by nurse practitioners, pediatric nurse practitioners, family nurse practitioners, certified nurse midwives and certified nurse anesthetists who are practicing compliance with the Nurse Practice Act of South Carolina, or of the state in which they practice, and have licenses that are active and in good standing.  Claims that are being filed by nurses who are qualified to practice independently and are filing under their own tax identification numbers are appropriate.  These claims should be filed with the valid HCPCS modifier that is defined for their specific services.  Also, claims for these services may be filed by the medical practice or the hospital that is the employer of the nurse practitioner.

There are no benefits for nonlicensed or certified "lay" midwives, as they do not meet the requirements and guidelines as outlined by the state Board of Nursing.

Nurse Practitioner means a registered nurse who has completed a post basic or an advanced formal education program acceptable to the State Board of Nursing, and who demonstrates advanced knowledge and skill in assessment and management of physical and psychosocial health-illness status of individuals, and/or families and/or groups.  A nurse practitioner who manages delegated medical aspects of care must have a supervising physician and operate within the "approved written protocols."  A certified nurse midwife is accepted by the Board as meeting requirements as "nurse practitioner."

Certified Registered Nurse Anesthetist means a registered nurse who has successfully completed an advanced, organized formal education program in nurse anesthesia accredited by the national certifying organization of such specialty area that is recognized by the Board, and is certified by a Board-approved national certifying organization and who demonstrates advanced knowledge and skill in the delivery of anesthesia services.  The Certified Registered Nurse Anesthetist must pr actice in accordance with approved written guidelines developed under the supervision of a licensed physician or dentist or approved by the medical staff within the facility where privileges have been granted.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

05/01/2019 

Annual review, no change to policy intent. 

05/02/2018 

Annual review, no change to policy intent. 

05/15/2017 

Annual review, no change to policy intent. 

05/03/2016 

Annual review, no change to policy intent. 

05/04/2015 

Annual review, no change to policy. 

05/5/2014 

Made policy external.

03/4/2014

Annual Review. No changes made.


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