---
kind: "section"
citation: "42 C.F.R. § 410.77"
title: "42"
number: "410.77"
heading: "Certified nurse-midwives' services: Qualifications and conditions."
url: "https://uscodex.org/cfr/42/410.77"
---

# §410.77. Certified nurse-midwives' services: Qualifications and conditions.

- (a) **Qualifications.** For Medicare coverage of his or her services, a certified nurse-midwife must:
  - (1) Be a registered nurse who is legally authorized to practice as a nurse-midwife in the State where services are performed;
  - (2) Have successfully completed a program of study and clinical experience for nurse-midwives that is accredited by an accrediting body approved by the U.S. Department of Education; and
  - (3) Be certified as a nurse-midwife by the American College of Nurse-Midwives or the American College of Nurse-Midwives Certification Council.
- (b) **Services.** A certified nurse-midwife's services are services furnished by a certified nurse-midwife and services and supplies furnished as an incident to the certified nurse-midwife's services that—
  - (1) Are within the scope of practice authorized by the law of the State in which they are furnished and would otherwise be covered if furnished by a physician or as an incident to a physician's service; and
  - (2) Unless required by State law, are provided without regard to whether the certified nurse-midwife is under the supervision of, or associated with, a physician or other health care provider.
- (c) **Incident to services: Basic rule.** Medicare Part B covers services and supplies incident to the services of a certified nurse-midwife if the requirements of [§ 410.26](/cfr/42/410.26.md) are met.
- (d) **Professional services.** A nurse-midwife can be paid for professional services only when the services have been performed personally by the nurse-midwife.
  - (1) Supervision of other nonphysician staff by a nurse-midwife does not constitute personal performance of a professional service by the nurse-midwife.
  - (2) The services of a certified nurse-midwife are provided on an assignment-related basis, and the certified nurse-midwife may not charge a beneficiary in excess of the amounts permitted under [42 CFR 424.55](/cfr/42/424.55.md). If a beneficiary has made payment for a service in excess of these limits, the certified nurse-midwife must refund the full amount of the impermissible charge to the beneficiary.
  - (3) A nurse-midwife may provide services that he or she is legally authorized to perform under State law as a nurse-midwife, if the services would otherwise be covered by the Medicare program when furnished by a physician or incident to a physicians' professional services.
- (e) **Medical record documentation.** For certified nurse-midwives' services, the certified nurse-midwife may review and verify (sign and date), rather than re-document, notes in a patient's medical record made by physicians; residents; nurses; medical, physician assistant, and advanced practice registered nurse students; or other members of the medical team, including, as applicable, notes documenting the certified nurse-midwife's presence and participation in the service.

## Notes

### Amendments

[63 FR 58909, Nov. 2, 1998, as amended at 78 FR 74811, Dec. 10, 2013; 84 FR 63191, Nov. 15, 2019; 86 FR 65665, Nov. 19, 2021]

### Authority

Authority: 42 U.S.C. 1302, 1395m, 1395hh, 1395rr, and 1395ddd.

### Source

Source: 51 FR 41339, Nov. 14, 1986, unless otherwise noted.

### Amendments

[63 FR 58909, Nov. 2, 1998, as amended at 78 FR 74811, Dec. 10, 2013; 84 FR 63191, Nov. 15, 2019; 86 FR 65665, Nov. 19, 2021]