Cal. Code Regs. tit. 22 § 51503.1

Current through Register 2024 Notice Reg. No. 49, December 6, 2024

Section 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.

Cal. Code Regs. Tit. 22, § 51503.1

1. New section filed 8-1-78 as an emergency; effective upon filing (Register 78, No. 31).
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 A Certificate of Compliance must be transmitted to OAL 8-31-93 or emergency language will be repealed by operation of law on the following day.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 A Certificate of Compliance must be transmitted to OAL by 2-25-94 or emergency language will be repealed by operation of law on the following day.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.

1. New section filed 8-1-78 as an emergency; effective upon filing (Register 78, No. 31).
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).