Section 410.32(b) of the Code of Federal Regulations requires that, with certain exceptions, diagnostic tests covered under §1861(s)(3) of the Social Security Act and payable under the physician fee schedule have to be performed under the supervision of an individual meeting the definition of a “physician”.
All diagnostic tests payable under the physician fee schedule must be furnished under at least a general level of physician supervision with the exception of certain procedures personally performed by the following:
Independent qualified psychologists
Clinical psychologists
Qualified audiologists
Physical therapists
Qualified electrophysiologic clinical specialists(certified by the American Board of Physical Therapy Specialties)
Note: Some tests also require either direct or personal supervision.
The regulation defines the levels of physician supervision for diagnostic tests as follows:
General supervision - the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure. Under general supervision, the training of the nonphysician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician.
Direct supervision in an office setting - the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.
Personal supervision - a physician must be in attendance in the room during the performance of the procedure.
This policy applies to technical components (TCs) (including TCs billed globally with the professional component (PC) of the procedure) and other diagnostic procedures, which do not have relative value units reflecting physician work. These supervision requirements do not apply to diagnostic tests furnished in hospitals.
Documentation maintained by the billing provider must be able to demonstrate that the required physician supervision is furnished. Services that are not performed under the appropriate supervision are not considered reasonable and necessary and, therefore, are not covered.
The level of supervision required for each diagnostic test is published by the Centers for Medicare & Medicaid Services as a part of the Medicare Physician Fee Schedule Database. To determine the level of supervision for a specific Healthcare Common Procedure Coding System or Current Procedural Terminology code, please refer to the Physician Supervision and Diagnostic Procedures indicator, located under Status Indicators, on the Physician’s Fee Schedule Code Search & Downloads (JH) (JL), available on our website.
Level |
Description |
1 |
Procedure must be performed under the general supervision of a physician. |
2 |
Procedure must be performed under the direct supervision of a physician. |
3 |
Procedure must be performed under the personal supervision of a physician. |
4 |
Physician supervision policy does not apply when procedure is furnished by a qualified, independent psychologist or a clinical psychologist or furnished under the general supervision of a clinical psychologist; otherwise must be performed under the general supervision of a physician. |
5 |
Physician supervision policy does not apply when procedure personally furnished by a qualified audiologist; otherwise must be performed under the general supervision of a physician. |
6 |
Procedure must be personally performed by a physician OR a physical therapist who is certified by the ABPTS as a qualified electrophysiologic clinical specialist and is permitted to provide the service under State law. |
6a |
Supervision standards for level 66 apply; in addition, the PT with ABPTS certification may supervise another PT but only the PT with ABPTS certification may bill. |
9 |
Concept does not apply. |
21 |
Procedure must be performed by a technician with certification under general supervision of a physician; otherwise must be performed under direct supervision of a physician. |
22 |
May be performed by a technician with on-line real-time contact with physician. |
66 |
Procedure must be performed by a physician or by a PT with ABPTS certification and certification in this specific procedure. |
77 |
Procedure must be performed by a PT with ABPTS certification or by a PT without certification under direct supervision of a physician, or by a technician with certification under general supervision of a physician. |
7a |
Supervision standards for level 77 apply; in addition, the PT with ABPTS certification may supervise another PT but only the PT with ABPTS certification may bill. |
0 |
Procedure is not a diagnostic test or procedure is a diagnostic test, which is not subject to the physician supervision policy. |
The following are not defined as physicians:
Nurse practitioners
Clinical nurse specialist
Physician assistants
They may not function as supervising physicians under the diagnostic tests benefit.
Note: When performing diagnostic tests, they are not required to meet the physician supervision requirements defined here. They may perform diagnostic tests pursuant to State scope of practice laws and under the applicable State requirements for physician supervision or collaboration.
Diagnostic tests need not meet the incident to requirements because the diagnostic tests benefit set forth in §1861(s)(3) of the Act is separate and distinct from the incident to benefit set forth in §1861(s)(2) of the Act,
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