Subject: 
Ultrasound is Now Back to General Physician Supervision

The following instructions, effective July 1, 2001, relate revised levels of physician supervision requirements for diagnostic tests payable under the Medicare physician fee schedule. Section 410.32(b) of the Code of Federal Regulations, as adopted in the Medicare physician fee schedule final rule of October 31, 1997, requires that diagnostic tests covered under §1861(s)(3) of the Social Security Act and payable under the physician fee schedule, with certain exceptions listed in the regulation, have to be performed under the supervision of an individual meeting the definition of a "physician"(§1861(r) of the Social Security Act) to be considered reasonable and necessary and, therefore, covered under Medicare. The regulation defines these levels of physician supervision for diagnostic tests as follows:

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 performs 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 that 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. The preamble to the final rule of October 31, 1997 assigned a level of physician supervision to most diagnostic tests payable under the physician fee schedule. Implementation of the levels set forth in the final rule was delayed by a memorandum to the HCFA regional offices dated January 28, 1998.

The following list provides the required level of physician supervision for tests performed under the provisions of 42 CFR 410.32(b).

Effective July 1, 2001, certain codes in the range of CPT 95860 through 95937 will have new supervision levels (either 21, 22, 6a, 66, 77 or 77a). This implementation date will make it possible for physical therapists to acquire the certification required to perform these services without supervision.

NOTE: Effective July 1, 2001, a physical therapist who is presently certified by the American Board of Physical Therapy Specialties can perform procedures assigned a level of 21, 22, 66, 6a, 77, or 77a without supervision.

Levels of Physician Supervision of Diagnostic Tests

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 personally furnished by a qualified, independent psychologist or 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 American Board of Physical Therapy Specialties (ABPTS) as a qualified electrophysiologic clinical specialist and is permitted to provide the service under State law.

Level of Physician Supervision of Specific Diagnostic Tests

URODYNAMICS

MALE GENITAL SYSTEM

ANTEPARTUM SERVICES

RESERVOIR/PUMP IMPLANTATION

DIAGNOSTIC RADIOLOGY

HEAD AND NECK

CHEST

SPINE AND PELVIS

UPPER EXTREMITIES

LOWER EXTREMITIES

ABDOMEN

GASTROINTESTINAL TRACT

URINARY TRACT

GYNECOLOGICAL AND OBSTETRICAL

HEART

AORTA AND ARTERIES

VEINS AND LYMPHATICS

TRANSCATHETER PROCEDURES

TRANSLUMINAL ATHERECTOMY

OTHER PROCEDURES