Code of Virginia § 38.2-4221. Services of certain practitioners other than physicians to be covered.
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/va/title-38-2/chapter-42/38-2-4221A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A. A nonstock corporation shall not fail or refuse, either directly or indirectly, to allow or to pay to a subscriber for all or any part of the health services rendered by any doctor of podiatry, doctor of chiropody, optometrist, optician, chiropractor, professional counselor, psychologist, physical therapist, clinical social worker, clinical nurse specialist, audiologist, speech pathologist, certified nurse midwife or other advanced practice registered nurse, licensed certified midwife, licensed midwife, marriage and family therapist, athletic trainer, or licensed acupuncturist licensed to practice in Virginia, if the services rendered
(i)are services provided for by the subscription contract;
(ii)are services which the doctor of podiatry, doctor of chiropody, optometrist, optician, chiropractor, professional counselor, psychologist, physical therapist, clinical social worker, clinical nurse specialist, audiologist, speech pathologist, certified nurse midwife or other advanced practice registered nurse, licensed certified midwife, licensed midwife, marriage and family therapist, athletic trainer, or licensed acupuncturist is licensed to render in this Commonwealth; and
(iii)are, for any services rendered by an athletic trainer, rendered in an office setting.
B. If a subscription contract provides reimbursement for a service that may be legally performed by a licensed pharmacist, reimbursement under the subscription contract by the nonstock corporation shall not be denied because the service is rendered by the licensed pharmacist provided that
(i)the service is performed for a subscriber for a condition under the terms of a collaborative agreement, as defined in § 54.1-3300 , between a pharmacist and the physician with whom the subscriber is undergoing a course of treatment or
(ii)the service is for the administration of vaccines for immunization. Notwithstanding the provisions of § 38.2-4209 , the nonstock corporation may require the pharmacist, any pharmacy or provider that may employ such pharmacist, or the collaborating physician to enter into a written agreement with the nonstock corporation as a condition for reimbursement for such services. In addition, reimbursement to pharmacists acting under the terms of a collaborative agreement under this subsection shall not be subject to the provisions of § 38.2-4209.1 .
C. The payment for a service provided by a licensed certified midwife or licensed midwife shall be in the same amount as the payment paid under the subscription contract for a certified nurse midwife performing such service in the area served, provided that the claim is submitted using
(i)the diagnoses and procedure codes applicable to the service;
(ii)such licensed certified midwife's or licensed midwife's name;
(iii)the national provider identifier for the licensed certified midwife or licensed midwife providing the service; and
(iv)if required by the nonstock corporation, the facility in which the service is provided.
D. No nonstock corporation shall reduce the reimbursement paid to a certified nurse midwife in order to comply with the provisions of this section.
Code 1950, § 32-195.10:1; 1966, c. 276, § 38.1-824; 1973, c. 428; 1979, cc. 13, 721; 1980, c. 682; 1986, c. 562; 1987, cc. 549, 551, 557; 1988, c. 522; 1989, cc. 7, 201; 1997, c. 203 ; 1998, c. 146 ; 2001, cc. 102 , 475 ; 2019, cc. 332 , 333 ; 2020, c. 726 ; 2022, cc. 440 , 441 ; 2023, c. 183 ; 2025, c. 695 .