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36.3.1 Supervision
Physician services include those reasonable and medically necessary services ordered and performed by physicians or under physicians' supervision that are within the scope of practice of their profession as defined by state law. For each encounter, unless an explicit exception is provided, the teaching/supervising physician must:
• Examine the patient.
•Confirm or revise the diagnosis of record.
•Confirm or revise a plan of care.
•Document these tasks in the appropriate medical records for the client before submitting claims.
If such documentation is not present in the appropriate medical record, any payment made may be recouped. The services are a benefit if provided in the office, client's home, hospital, nursing facility, or elsewhere.
Physician services must be performed by the teaching or supervising physician personally or by the person to whom the physician has delegated the responsibility. The level of supervision required may be direct or personal.
Physician assistants (PAs) and advanced practice nurses (APNs) who provide physician or facility services, must submit the appropriate procedure codes with the modifiers U7 or SA. These modifiers identity the services as performed by a PA or an APN. To provide Medicaid services, each nurse practitioner (NP), clinical nurse specialist (CNS), certified nurse-midwife (CNM), and certified registered nurse anesthetist (CRNA) must be licensed as a registered nurse and recognized as an APN by the Texas Board of Nursing (BON).
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