{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-4221.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-4221.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-4221.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-4221.html"}],"law_id":74708,"edition_id":1,"section_id":74708,"structure_id":12968,"section_number":"38.2-4221","catch_line":"Services of certain practitioners other than physicians to be covered","history":"Code 1950, \u00a7 32-195.10:1; 1966, c. 276, \u00a7 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.","full_text":"A\n\nA 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\n\nIf 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\n\nThe 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\n\nNo nonstock corporation shall reduce the reimbursement paid to a certified nurse midwife in order to comply with the provisions of this section.","order_by":null,"text":{"0":{"id":268517,"text":"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.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":268518,"text":"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.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":268519,"text":"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.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":268520,"text":"No nonstock corporation shall reduce the reimbursement paid to a certified nurse midwife in order to comply with the provisions of this section.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"ancestry":[{"id":12968,"edition_id":1,"name":"In General","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":12967,"metadata":{},"date_created":"2026-06-26 03:44:05","date_modified":"2026-06-26 03:44:05","permalink":{"id":216659,"object_type":"structure","relational_id":12968,"identifier":"1","token":"38.2\/42\/1","url":"\/38.2\/42\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12967,"edition_id":1,"name":"Health Services 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thereon","url":"\/38.2-4219\/","token":"38.2\/42\/1\/38.2-4219","metadata":false},{"id":57164,"structure_id":12968,"section_number":"38.2-4220","catch_line":"Interplan arrangements","url":"\/38.2-4220\/","token":"38.2\/42\/1\/38.2-4220","metadata":false},{"id":74708,"structure_id":12968,"section_number":"38.2-4221","catch_line":"Services of certain practitioners other than physicians to be covered","url":"\/38.2-4221\/","token":"38.2\/42\/1\/38.2-4221","metadata":false},{"id":70849,"structure_id":12968,"section_number":"38.2-4222","catch_line":"Licensing of nonstock corporations","url":"\/38.2-4222\/","token":"38.2\/42\/1\/38.2-4222","metadata":false},{"id":68899,"structure_id":12968,"section_number":"38.2-4223","catch_line":"Renewal of license","url":"\/38.2-4223\/","token":"38.2\/42\/1\/38.2-4223","metadata":false},{"id":63881,"structure_id":12968,"section_number":"38.2-4224","catch_line":"Licensing of 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contracts","url":"\/38.2-4228\/","token":"38.2\/42\/1\/38.2-4228","metadata":false},{"id":60792,"structure_id":12968,"section_number":"38.2-4229","catch_line":"Reinsurance","url":"\/38.2-4229\/","token":"38.2\/42\/1\/38.2-4229","metadata":false},{"id":86012,"structure_id":12968,"section_number":"38.2-4229.1","catch_line":"Conversion to domestic mutual insurer","url":"\/38.2-4229.1\/","token":"38.2\/42\/1\/38.2-4229.1","metadata":false},{"id":82144,"structure_id":12968,"section_number":"38.2-4229.2","catch_line":"Hearings and investigations on effect of other state's law","url":"\/38.2-4229.2\/","token":"38.2\/42\/1\/38.2-4229.2","metadata":false}],"previous_section":{"id":57164,"structure_id":12968,"section_number":"38.2-4220","catch_line":"Interplan arrangements","url":"\/38.2-4220\/","token":"38.2\/42\/1\/38.2-4220","metadata":false},"next_section":{"id":70849,"structure_id":12968,"section_number":"38.2-4222","catch_line":"Licensing of nonstock corporations","url":"\/38.2-4222\/","token":"38.2\/42\/1\/38.2-4222","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-4221\/","history_text":"

The record of this law\u2019s original creation isn\u2019t available online. It has been modified 16 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1966, chapter 276; in 1973, chapter 428; in 1979, chapters 13 and 721; in 1980, chapter 682; in 1986, chapter 562; in 1987, chapters 549, 551, and 557; in 1988, chapter 522; in 1989, chapters 7 and 201; in 1997, chapter 203<\/a>; in 1998, chapter 146<\/a>; in 2001, chapters 102<\/a> and 475<\/a>; in 2019, chapters 332<\/a> and 333<\/a>; in 2020, chapter 726<\/a>; in 2022, chapters 440<\/a> and 441<\/a>; in 2023, chapter 183<\/a>; in 2025, chapter 695<\/a>.<\/p>","references":[{"id":84333,"section_number":"38.2-3406.1","catch_line":"Application of requirements that policies offered by small employers include state-mandated health benefits","order_by":null,"url":"\/38.2-3406.1\/"},{"id":68442,"section_number":"38.2-3407.12","catch_line":"Patient optional point-of-service benefit","order_by":null,"url":"\/38.2-3407.12\/"},{"id":80669,"section_number":"38.2-4209","catch_line":"Preferred provider subscription contracts","order_by":null,"url":"\/38.2-4209\/"},{"id":62703,"section_number":"38.2-4312","catch_line":"Prohibited practices","order_by":null,"url":"\/38.2-4312\/"}],"refers_to":[{"id":80669,"section_number":"38.2-4209","catch_line":"Preferred provider subscription contracts","order_by":null,"url":"\/38.2-4209\/"},{"id":72064,"section_number":"54.1-3300","catch_line":"Definitions","order_by":null,"url":"\/54.1-3300\/"}],"permalink":{"id":216765,"object_type":"law","relational_id":74708,"identifier":"38.2-4221","token":"38.2\/42\/1\/38.2-4221","url":"\/38.2-4221\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-4221\/","token":"38.2\/42\/1\/38.2-4221","dublin_core":{"Title":"Services of certain practitioners other than physicians to be covered","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-4221","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> A nonstock corporation<\/span> shall not fail or refuse, either directly or indirectly, to allow or to pay to a subscriber<\/span> 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<\/span>; (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. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> If a subscription contract<\/span> provides reimbursement for a service that may be legally performed by a licensed pharmacist, reimbursement under the subscription contract<\/span> by the nonstock corporation<\/span> shall not be denied because the service is rendered by the licensed pharmacist provided that (i) the service is performed for a subscriber<\/span> for a condition under the terms of a collaborative agreement, as defined in § 54.1-3300<\/a>, between a pharmacist and the physician with whom the subscriber<\/span> 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<\/a>, the nonstock corporation<\/span> 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<\/span> 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<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> 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<\/span> 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<\/span>, the facility in which the service is provided. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> No nonstock corporation<\/span> shall reduce the reimbursement paid to a certified nurse midwife in order<\/span> to comply with the provisions of this section. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nSERVICES OF CERTAIN PRACTITIONERS OTHER THAN PHYSICIANS TO BE COVERED (\u00a7\n38.2-4221)\n\nA. A nonstock corporation shall not fail or refuse, either directly or\nindirectly, to allow or to pay to a subscriber for all or any part of the health\nservices rendered by any doctor of podiatry, doctor of chiropody, optometrist,\noptician, chiropractor, professional counselor, psychologist, physical\ntherapist, clinical social worker, clinical nurse specialist, audiologist,\nspeech pathologist, certified nurse midwife or other advanced practice\nregistered nurse, licensed certified midwife, licensed midwife, marriage and\nfamily therapist, athletic trainer, or licensed acupuncturist licensed to\npractice in Virginia, if the services rendered (i) are services provided for by\nthe subscription contract; (ii) are services which the doctor of podiatry,\ndoctor of chiropody, optometrist, optician, chiropractor, professional\ncounselor, psychologist, physical therapist, clinical social worker, clinical\nnurse specialist, audiologist, speech pathologist, certified nurse midwife or\nother advanced practice registered nurse, licensed certified midwife, licensed\nmidwife, marriage and family therapist, athletic trainer, or licensed\nacupuncturist is licensed to render in this Commonwealth; and (iii) are, for any\nservices rendered by an athletic trainer, rendered in an office setting.\n\nB. If a subscription contract provides reimbursement for a service that may be\nlegally performed by a licensed pharmacist, reimbursement under the subscription\ncontract by the nonstock corporation shall not be denied because the service is\nrendered by the licensed pharmacist provided that (i) the service is performed\nfor a subscriber for a condition under the terms of a collaborative agreement,\nas defined in § 54.1-3300, between a pharmacist and the physician with whom\nthe subscriber is undergoing a course of treatment or (ii) the service is for\nthe administration of vaccines for immunization. Notwithstanding the provisions\nof § 38.2-4209, the nonstock corporation may require the pharmacist, any\npharmacy or provider that may employ such pharmacist, or the collaborating\nphysician to enter into a written agreement with the nonstock corporation as a\ncondition for reimbursement for such services. In addition, reimbursement to\npharmacists acting under the terms of a collaborative agreement under this\nsubsection shall not be subject to the provisions of § 38.2-4209.1.\n\nC. The payment for a service provided by a licensed certified midwife or\nlicensed midwife shall be in the same amount as the payment paid under the\nsubscription contract for a certified nurse midwife performing such service in\nthe area served, provided that the claim is submitted using (i) the diagnoses\nand procedure codes applicable to the service; (ii) such licensed certified\nmidwife’s or licensed midwife’s name; (iii) the national provider\nidentifier for the licensed certified midwife or licensed midwife providing the\nservice; and (iv) if required by the nonstock corporation, the facility in which\nthe service is provided.\n\nD. No nonstock corporation shall reduce the reimbursement paid to a certified\nnurse midwife in order to comply with the provisions of this section.\n\nHISTORY: Code 1950, \u00a7 32-195.10:1; 1966, c. 276, \u00a7 38.1-824; 1973, c. 428;\n1979, cc. 13, 721; 1980, c. 682; 1986, c. 562; 1987, cc. 549, 551, 557; 1988, c.\n522; 1989, cc. 7, 201; 1997, c. 203; 1998, c. 146; 2001, cc. 102, 475; 2019, cc.\n332, 333; 2020, c. 726; 2022, cc. 440, 441; 2023, c. 183; 2025, c. 695.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}