Diagnostic Supervisory Regulations

Objective

To apprise CUIMC clinicians, billing personnel and administrative personnel of the Medicare rules regarding supervision of diagnostic tests.

Policy

In order for a diagnostic test to be payable under Medicare, it must be ordered by the physician that is treating the patient and, with certain limited exceptions, must be furnished under the appropriate level of physician supervision. Medicare regulations establish three levels of supervision required for furnishing and billing the technical component of diagnostic tests for a Medicare beneficiary who is not a hospital inpatient or outpatient.

  • General Supervision- The procedure is performed under the physician’s overall direction and control. They physician does not have to be physically present for the procedure. The training of the non-physician personnel performing the procedure and the maintenance of the necessary equipment and supplies are the responsibility of the physician.
  • Direct supervision- The physician must be present in the office suite and immediately available for assistance and direction throughout the performance of the procedure. The physician does not have to be in the room during the procedure.
  • Personal supervision- The physician must be in the room during the performance of the procedure.

When NPs, CNSs, and PAs personally perform diagnostic tests as provided under Section 1861(s)(2)(K) of the Act, the supervision/collaboration requirements under Section 1861(s)(3) of the Act and 42 CFR 410.32 don’t apply. Rather, these practitioners are authorized to personally perform diagnostic tests under the supervision/collaboration requirements applicable to their practitioner benefit category pursuant to state scope of practice laws and under the applicable practitioner benefit category pursuant to state scope of practice laws and under the applicable state requirements.

Because the diagnostic tests benefit category in Section 1861(s)(3) of the Act is separately listed and distinct from the incident to benefit category in Section 1861(s)(2)(A) of the Act, diagnostic tests can’t be billed to Medicare as incident to services. Accordingly, the supervision requirements under the incident to benefit category aren’t applicable to the diagnostic tests benefit category.

 

 

 

 

Office for Billing Compliance
Policy#: 10028
Original Date of Issue: 1996
Revised: 3/22/2023
Reviewed: 3/1/2024