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When the MDM option is chosen for E and M coding and billing, the requirements apply to medical doctors, doctors of osteopathy, doctors of optometry and qualified health care professionals such as nurse practitioners or physician assistants who are licensed to practice medicine. Although ophthalmic medical personnel, assistants, technicians, orthoptists and opticians are well trained, they may not bill for E and M services. Even when they are certified, they are not licensed to practice medicine