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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 Centers for Medicare & Medicaid Services (CMS) specifies the levels of physician supervision required for over 700 diagnostic tests payable under the Medicare physician fee schedule. These should not be confused with supervision requirements for "incident to" billing. The CMS regulation defines the levels of physician supervision for diagnostic tests as follows:

General supervision: The testing 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 non-physician personnel who actually perform the diagnostic procedure and the maintenance of the equipment and supplies are the continuing responsibility of the physician.

Direct supervision: The physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. The physician does not have to be present in the room when the procedure is performed.

Personal supervision: The physician must be in attendance in the room during the performance of the procedure.

Many codes commonly used by urologists are affected. For a list of codes in each category, click here.

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


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