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PRACTICE RESOURCES > Coding and Reimbursement > Coding Tips > Questions and Answers > Physician Supervision

Physician Supervision

Q. What are the levels of supervision for diagnostic testing?

A. It is important to understand that the requirements for physician supervision are different for the various types of services provided to patients. Supervision rules under the "incident to" requirements of Medicare are significantly different from the rules for supervising diagnostic tests. However, the levels of supervision descriptions are the same, only the application varies from service to service.

The supervision level required for diagnostic services is assigned by the Centers for Medicare & Medicaid Services (CMS). A list of diagnostic procedures and the supervision level required for each service is available in the CMS Medicare Physician Fee Schedule Database.

Many codes commonly used by urologists are affected. For a list of codes in each category, visit the CMS website.

Once on the site follow these steps to view the physician supervision level:

  1. Select Physician Fee Schedule Search from the left area of the Web page
  2. Screen defaults to the current year. Under Type of Information, select Payment Policy Indicators, then "next"
  3. On the "select field options" screen, select "next"
  4. Enter the procedure code and select "All Modifiers," then click "Submit"
  5. Click "Submit." The payment policy information should appear
  6. Look in the "Phys Supr" column

Definitions: Levels of Supervision

General Supervision – means 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 perform the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician.

Direct Supervision – in the office setting means 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 the physician must be present in the room when the procedure is performed.

Personal Supervision – means a physician must be in attendance in the room during the performance of the procedure.

Supervision Indicator Explanation
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 is furnished by a qualified audiologist; otherwise must be performed under the general supervision of a physician.
6 Procedure must be performed by a physician or by a physical therapist (PT) who is certified by the American Board of Physical Therapy Specialties (ABPTS) as a qualified electrophysiologic clinical specialist and is permitted to provide the procedure 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.
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.
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 Procedure 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.

The supervision level definitions may also be found in the Internet Only Manual System, Publication 100-02, Chapter 15, Section 80.

Contact your Medicare Contractor for further questions or concerns about coverage of these tests.

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