Wednesday, July 29, 2015

Physician supervision of diagnostic procedures


This field provides levels of physician supervision required for diagnostic tests payable under the physician fee schedule.

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.

01 -- Procedure must be performed under the general supervision of a physician.
02 -- Procedure must be performed under the direct supervision of a physician.
03 -- Procedure must be performed under the personal supervision of a physician.
04 -- Physician supervision policy does not apply when procedure is furnished by a qualified, independent psychologist or a clinical psychologist; otherwise must be performed under the general supervision of a physician.

05 -- Not subject to supervision when furnished personally by a qualified audiologist, physician or nonphysician practitioner. Direct supervision by a physician is required for those parts of the test that may be furnished by a qualified technician when appropriate to the circumstances of the test.
06 -- Procedure must be performed by a physician or 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.
21 -- Procedure may 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 -- May be performed by a physician or by a physical therapist with ABPTS certification and certification in this specific procedure.
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.
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.
09 -- Concept does not apply.

Facility pricing
Facility fees are calculated at a national level with a reduced practice expense because of reduced physician overhead associated with services provided in a facility.

Place of service (POS) codes to be used to identify facilities are:
21-- Inpatient hospital
22 -- Outpatient hospital
23 -- Emergency room-hospital
24 -- Ambulatory surgical center - In a Medicare approved ASC, for an approved procedure on the ASC list, Medicare pays the lower facility fee to physicians. Beginning with dates of service January 1, 2008, in a Medicare approved ASC, for procedures NOT on the ASC list of approved procedures, contractors will also pay the lower facility fee to physicians.
26 -- Military treatment facility
31 -- Skilled nursing facility
34 – Hospice
41 -- Ambulance -- land
42 -- Ambulance air or water
51 -- Inpatient psychiatric facility
52 -- Psychiatric facility partial hospitalization
53 -- Community mental health center
56 -- Psychiatric residential treatment facility
61 -- Comprehensive inpatient rehabilitation facility

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