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LA Medicare Part B  

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

CODE

LEVEL

CODE

LEVEL

CODE

LEVEL

URODYNAMICS

51725 & TC

2

51726 & TC

2

51736 & TC

2

51741 & TC

2

51772 & TC

2

51784 & TC

2

51785 & TC

3

51792 & TC

2

51795 & TC

2

51797 & TC

2

       

MALE GENITAL SYSTEM

54240 & TC

2

54250 & TC

1

   

ANTEPARTUM SERVICES

59020 & TC

2

59025 & TC

1

   

RESERVOIR/PUMP IMPLANTATION

62367 & TC

2

62368 & TC

2

   

DIAGNOSTIC RADIOLOGY

HEAD AND NECK

70010 & TC

3

70015 & TC

3

70030 & TC

1

70100 & TC

1

70110 & TC

1

70120 & TC

1

70130 & TC

1

70134 & TC

1

70140 & TC

1

70150 & TC

1

70160 & TC

1

70170 & TC

3

70190 & TC

1

70200 & TC

1

70210 & TC

1

70220 & TC

1

70240 & TC

1

70250 & TC

1

70260 & TC

1

70300 & TC

1

70310 & TC

1

70320 & TC

1

70328 & TC

1

70330 & TC

1

70332 & TC

3

70336 & TC

2

70350 & TC

1

70355 & TC

1

70360 & TC

1

70370 & TC

3

70371 & TC

3

70373 & TC

3

70380 & TC

1

70390 & TC

3

70450 & TC

1

70460 & TC

2

70470 & TC

2

70480 & TC

1

70481 & TC

2

70482 & TC

2

70486 & TC

1

70487 & TC

2

70488 & TC

2

70490 & TC

1

70491 & TC

2

70492 & TC

2

70540 & TC

1

70541 & TC

2

70551 & TC

1

70552 & TC

2

70553 & TC

2

CHEST

71010 & TC

1

71015 & TC

1

71020 & TC

1

71021 & TC

1

71022 & TC

1

71023 & TC

3

71030 & TC

1

71034 & TC

3

71035 & TC

1

71036 & TC

3

71040 & TC

3

71060 & TC

3

71090 & TC

3

71100 & TC

1

71101 & TC

1

71110 & TC

1

71111 & TC

1

71120 & TC

1

71130 & TC

1

71250 & TC

1

71260 & TC

2

71270 & TC

2

71550 & TC

1

71555 & TC

2

SPINE AND PELVIS

72010 & TC

1

72020 & TC

1

72040 & TC

1

72050 & TC

1

72052 & TC

1

72069 & TC

1

72070 & TC

1

72072 & TC

1

72074 & TC

1

72080 & TC

1

72090 & TC

1

72100 & TC

1

72110 & TC

1

72114 & TC

1

72120 & TC

1

72125 & TC

1

72126 & TC

2

72127 & TC

2

72128 & TC

1

72129 & TC

2

72130 & TC

2

72131 & TC

1

72132 & TC

2

72133 & TC

2

72141 & TC

1

72142 & TC

2

72146 & TC

1

72147 & TC

2

72148 & TC

1

72149 & TC

2

72156 & TC

2

72157 & TC

2

72158 & TC

2

72170 & TC

1

72190 & TC

1

72192 & TC

1

72193 & TC

2

72194 & TC

2

72196 & TC

1

72200 & TC

1

72202 & TC

1

72220 & TC

1

72240 & TC

3

72255 & TC

3

72265 & TC

3

72270 & TC

3

72285 & TC

3

72295 & TC

3

UPPER EXTREMITIES

73000 & TC

1

73010 & TC

1

73020 & TC

1

73030 & TC

1

73040 & TC

3

73050 & TC

1

73060 & TC

1

73070 & TC

1

73080 & TC

1

73085 & TC

3

73090 & TC

1

73092 & TC

1

73100 & TC

1

73110 & TC

1

73115 & TC

3

73120 & TC

1

73130 & TC

1

73140 & TC

1

73200 & TC

1

73201 & TC

2

73202 & TC

2

73220 & TC

1

73221 & TC

1

   

LOWER EXTREMITIES

73500 & TC

1

73510 & TC

1

73520 & TC

1

73525 & TC

3

73530 & TC

3

73540 & TC

1

73550 & TC

1

73560 & TC

1

73562 & TC

1

73564 & TC

1

73565 & TC

1

73580 & TC

3

73590 & TC

1

73592 & TC

1

73600 & TC

1

73610 & TC

1

73615 & TC

3

73620 & TC

1

73630 & TC

1

73650 & TC

1

73660 & TC

1

73700 & TC

1

73701 & TC

2

73702 & TC

2

73720 & TC

1

73721 & TC

1

73725 & TC

2

ABDOMEN

74000 & TC

1

74010 & TC

1

74020 & TC

1

74022 & TC

1

74150 & TC

1

74160 & TC

2

74170 & TC

2

74181 & TC

1

74185 & TC

2

74190 & TC

3

       

GASTROINTESTINAL TRACT

74210 & TC

3

74220 & TC

3

74230 & TC

3

74235 & TC

3

74240 & TC

3

74241 & TC

3

74245 & TC

3

74246 & TC

3

74247 & TC

3

74249 & TC

3

74250 & TC

2

74251 & TC

3

74260 & TC

3

74270 & TC

3

74280 & TC

3

74283 & TC

3

74290 & TC

1

74291 & TC

1

74300 & TC

3

74301 & TC

3

74305 & TC

3

74320 & TC

3

74327 & TC

3

74328 & TC

3

74329 & TC

3

74330 & TC

3

74340 & TC

3

74350 & TC

3

74355 & TC

3

74360 & TC

3

74363 & TC

3

       

URINARY TRACT

74400 & TC

2

74410 & TC

2

74415 & TC

2

74420 & TC

3

74425 & TC

3

74430 & TC

3

74440 & TC

3

74445 & TC

3

74450 & TC

3

74455 & TC

3

74470 & TC

3

74475 & TC

3

74480 & TC

3

74485 & TC

3

   

GYNECOLOGICAL AND OBSTETRICAL

74710 & TC

1

74740 & TC

3

74742 & TC

3

74775 & TC

3

       

HEART

75552 & TC

1

75553 & TC

2

75554 & TC

1

75555 & TC

1

       

AORTA AND ARTERIES

75600 & TC

3

75605 & TC

3

75625 & TC

3

75630 & TC

3

75650 & TC

3

75658 & TC

3

75660 & TC

3

75662 & TC

3

75665 & TC

3

75671 & TC

3

75676 & TC

3

75680 & TC

3

75685 & TC

3

75705 & TC

3

75710 & TC

3

75716 & TC

3

75722 & TC

3

75724 & TC

3

75726 & TC

3

75731 & TC

3

75733 & TC

3

75736 & TC

3

75741 & TC

3

75743 & TC

3

75746 & TC

3

75756 & TC

3

75774 & TC

3

75790 & TC

3

       

VEINS AND LYMPHATICS

75801 & TC

3

75803 & TC

3

75805 & TC

3

75807 & TC

3

75809 & TC

3

75810 & TC

3

75820 & TC

3

75822 & TC

3

75825 & TC

3

75827 & TC

3

75831 & TC

3

75833 & TC

3

75840 & TC

3

75842 & TC

3

75860 & TC

3

75870 & TC

3

75872 & TC

3

75880 & TC

3

75885 & TC

3

75887 & TC

3

75889 & TC

3

75891 & TC

3

75893 & TC

3

   

TRANSCATHETER PROCEDURES

75894 & TC

3

75896 & TC

3

75898 & TC

3

75900 & TC

3

75940 & TC

3

75945 & TC

3

75946 & TC

3

75960 & TC

3

75961 & TC

3

75962 & TC

3

75964 & TC

3

75966 & TC

3

75968 & TC

3

75970 & TC

3

75978 & TC

3

75980 & TC

3

75982 & TC

3

75984 & TC

3

75989 & TC

3

       

TRANSLUMINAL ATHERECTOMY

75992 & TC

3

75993 & TC

3

75994 & TC

3

75995 & TC

3

75996 & TC

3

   

OTHER PROCEDURES

76000 & TC

3

76001 & TC

3

76003 & TC

3

76010 & TC

1

76020 & TC

1

76040 & TC

1

76061 & TC

1

76062 & TC

1

76065 & TC

1

76066 & TC

1

76070 & TC

1

76075 & TC

1

76076 & TC

1

76078 & TC

1

76080 & TC

3

76086 & TC

3

76088 & TC

3

76093 & TC

1

76094 & TC

1

76095 & TC

3

76096 & TC

3

76098 & TC

1

76100 & TC

2

76101 & TC

2

76102 & TC

2

76120 & TC

2

76125 & TC

2

76150

1

76350

2

76355 & TC

3

76360 & TC

3

76365 & TC

3

76370 & TC

2

76375 & TC

1

76380 & TC

1

76400 & TC

1

DIAGNOSTIC ULTRASOUND

HEAD AND NECK

76506 & TC

2

76511 & TC

3

76512 & TC

3

76513 & TC

3

76516 & TC

2

76519 & TC

2

76529 & TC

2

76536 & TC

1

   

CHEST

76604 & TC

1

76645 & TC

1

ABDOMEN AND RETROPERITONEUM

76700 & TC

1

76705 & TC

1

76770 & TC

1

76775 & TC

1

76778 & TC

1

   

SPINAL CANAL

76800 & TC

2

PELVIS

76805 & TC

2

76810 & TC

2

76815 & TC

2

76816 & TC

1

76818 & TC

1

76825 & TC

2

76826 & TC

1

76827 & TC

1

76828 & TC

1

76830 & TC

1

76831 & TC

3

76856 & TC

1

76857 & TC

1

76870 & TC

1

76872 & TC

1

EXTREMITIES

76880 & TC

1

76885 & TC

2

76886 & TC

1

VASCULAR STUDIES

ULTRASONIC GUIDANCE PROCEDURES

76930 & TC

3

76932 & TC

3

76934 & TC

3

76936 & TC

3

76938 & TC

3

76941 & TC

3

76942 & TC

3

76945 & TC

3

76946 & TC

3

76948 & TC

3

76950 & TC

3

76960 & TC

3

76965 & TC

3

       

OTHER PROCEDURES

76970 & TC

1

76975 & TC

3

76977 & TC

1

76986 & TC

3

       

RADIATION ONCOLOGY

77417

1

DIAGNOSTIC NUCLEAR MEDICINE

ENDOCRINE SYSTEM

78000 & TC

1

78001 & TC

1

78003 & TC

1

78006 & TC

1

78007 & TC

1

78010 & TC

1

78011 & TC

1

78015 & TC

1

78016 & TC

1

78018 & TC

1

78070 & TC

1

78075 & TC

1

HEMATOPOIETIC, RETICULOENDOTHELIAL, AND LYMPHATIC SYSTEM

78102 & TC

1

78103 & TC

1

78104 & TC

1

78110 & TC

1

78111 & TC

1

78120 & TC

1

78121 & TC

1

78122 & TC

1

78130 & TC

1

78135 & TC

1

78140 & TC

1

78160 & TC

1

78162 & TC

1

78170 & TC

1

78172 & TC

1

78185 & TC

1

78190 & TC

1

78191 & TC

1

78195 & TC

1

GASTROINTESTINAL SYSTEM

78201 & TC

1

78202 & TC

1

78205 & TC

1

78206 & TC

1

78215 & TC

1

78216 & TC

1

78220 & TC

1

78223 & TC

1

78230 & TC

1

78231 & TC

1

78232 & TC

1

78258 & TC

1

78261 & TC

1

78262 & TC

1

78264 & TC

1

78270 & TC

1

78271 & TC

1

78272 & TC

1

78278 & TC

1

78282 & TC

1

78290 & TC

1

78291 & TC

1

       

MUSCULOSKELETAL SYSTEM

78300 & TC

1

78305 & TC

1

78306 & TC

1

78315 & TC

1

78320 & TC

1

78350 & TC

1

CARDIOVASCULAR SYSTEM

78414 & TC

1

78428 & TC

1

78445 & TC

1

78455 & TC

1

78457 & TC

1

78458 & TC

1

78460 & TC

1

78461 & TC

1

78464 & TC

1

78465 & TC

1

78466 & TC

1

78468 & TC

1

78469 & TC

1

78472 & TC`

1

78473 & TC

1

78478 & TC

1

78480 & TC

1

78481 & TC

1

78483 & TC

1

78494 & TC

1

78496 & TC

1

RESPIRATORY SYSTEM

78580 & TC

1

78584 & TC

1

78585 & TC

1

78586 & TC

1

78587 & TC

1

78588 & TC

1

78591 & TC

1

78593 & TC

1

78594 & TC

1

78596 & TC

1

       

NERVOUS SYSTEM

78600 & TC

1

78601 & TC

1

78605 & TC

1

78606 & TC

1

78607 & TC

1

78610 & TC

1

78615 & TC

1

78630 & TC

1

78635 & TC

1

78645 & TC

1

78647 & TC

1

78650 & TC

1

78660 & TC

1

       

GENITOURINARY SYSTEM

78700 & TC

1

78701 & TC

1

78704 & TC

1

78707 & TC

1

78708 & TC

1

78709 & TC

1

78710 & TC

1

78715 & TC

1

78725 & TC

1

78730 & TC

1

78740 & TC

1

78760 & TC

1

78761 & TC

1

       

OTHER DIAGNOSTIC NUCLEAR MEDICINE PROCEDURES

78800 & TC

1

78801 & TC

1

78802 & TC

1

78803 & TC

1

78805 & TC

1

78806 & TC

1

78807 & TC

1

78990

1

   

MEDICINE

GASTROINTESTINAL

91000 & TC

3

91010 & TC

3

91011 & TC

3

91012 & TC

3

91020 & TC

3

91030 & TC

3

91032 & TC

3

91033 & TC

3

91052 & TC

3

91055 & TC

3

91060 & TC

3

91065 & TC

1

91122 & TC

3

       

SPECIAL OPHTHALMOLOGICAL SERVICES

92060 & TC

1

92065 & TC

1

92081 & TC

1

92082 & TC

1

92083 & TC

1

92135 & TC

1

92235 & TC

2

92240 & TC

2

92250 & TC

1

OTHER SPECIALIZED SERVICES

92265 & TC

3

92270 & TC

3

92275 & TC

3

92283 & TC

1

92284 & TC

1

92285 & TC

2

92286 & TC

3

       

VESTIBULAR FUNCTION TESTS WITH RECORDING

92541 & TC

5

92542 & TC

5

92543 & TC

5

92544 & TC

5

92545 & TC

5

92546 & TC

5

92547

5

92548 & TC

5

   

AUDIOLOGIC FUNCTION TESTS

92552

5

92553

5

92555

5

92556

5

92557

5

92561

5

92562

5

92563

5

92564

5

92565

5

92567

5

92568

5

92569

5

92571

5

92572

5

92573

5

92575

5

92576

5

92577

5

92579

5

92582

5

92583

5

92584

5

92585 & TC

5

92587 & TC

5

92588 & TC

5

92589

5

92596

5

       

CARDIOGRAPHY

93000

1

93005

1

93012

1

93015

2

93016

2

93017

2

93024 & TC

3

93040

1

93041

1

93224

1

93225

1

93226

1

93230

1

93231

1

93232

1

93235

1

93236

1

93268

1

93270

1

93271

1

93278 & TC

1

ECHOCARDIOGRAPHY

93303 & TC

1

93304 & TC

1

93307& TC

1

93308 & TC

1

93312 & TC

3

93313

3

93314

3

93315 & TC

3

93316

3

93317

3

93320 & TC

1

93321 & TC

1

93325 & TC

1

93350 & TC

1

   

CARDIAC CATHETERIZATION

93501 & TC

3

93505 & TC

3

93508 & TC

3

93510 & TC

3

93511 & TC

3

93514 & TC

3

93524 & TC

3

93526 & TC

3

93527 & TC

3

93528 & TC

3

93529 & TC

3

93530 & TC

3

93531 & TC

3

93532 & TC

3

93533 & TC

3

93555 & TC

3

93556 & TC

3

93561 & TC

3

93562 & TC

3

93571 & TC

3

93572 & TC

3

INTRACARDIAC ELECTROPHYSIOLOGICAL PROCEDURES

93600 & TC

3

93602 & TC

3

93603 & TC

3

93607 & TC

3

93609 & TC

3

93610 & TC

3

93612 & TC

3

93615 & TC

3

93616 & TC

3

93618 & TC

3

93619 & TC

3

93620 & TC

3

93621 & TC

3

93622 & TC

3

93623 & TC

3

93624 & TC

3

93631 & TC

3

93640 & TC

3

93641 & TC

3

93642 & TC

3

93660 & TC

3

OTHER VASCULAR STUDIES

93720

1

93721

1

93724 & TC

3

93731 & TC

2

93732 & TC

2

93733 & TC

1

93734 & TC

2

93735 & TC

2

93736 & TC

1

93737 & TC

2

93738 & TC

2

   

93740 & TC

1

93770 & TC

1

   

CEREBROVASCULAR ARTERIAL STUDIES

93875 & TC

1

93880 & TC

1

93882 & TC

1

93886 & TC

1

93888 & TC

1

   

EXTREMITY ARTERIAL STUDIES

93922 & TC

1

93923 & TC

1

93924 & TC

1

93925 & TC

1

93926 & TC

1

93930 & TC

1

93931 & TC

1

       

EXTREMITY VENOUS STUDIES

93965 & TC

1

93970 & TC

1

93971 & TC

1

VISCERAL AND PENILE VASCULAR STUDIES

93975 & TC

1

93976 & TC

1

93978 & TC

1

93979 & TC

1

93980 & TC

1

93981 & TC

1

EXTREMITY ARTERIAL-VENOUS STUDIES

93990 & TC

1

PULMONARY

94010 & TC

1

94014

1

94015

1

94060 & TC

2

94070 & TC

2

   

94200 & TC

1

94240 & TC

1

   

94250 & TC

1

94260 & TC

1

94350 & TC

1

94360 & TC

1

94370 & TC

1

94375 & TC

1

94400 & TC

2

94450 & TC

2

94620 & TC

1

94621 & TC

2

94664

2

94665

2

94680 & TC

2

94681 & TC

2

94690 & TC

1

94720 & TC

1

94725 & TC

1

94750 & TC

1

94760

1

94761

1

94762

1

94770 & TC

1

94772 & TC

1

   

ALLERGY

95004

2

95024

2

95027

2

95028

2

95044

2

95052

2

95056

2

95060

3

95065

3

95070

3

95071

3

   

95078

3

       

For certain codes within the range of CPT 95860 through 95937, the following additional criteria apply.

NOTE: a All level of supervision standards for the lead number ("6" or "7") apply; in addition, the PT with ABPTS certification may personally supervise another PT but only the PT with ABPTS certification may bill.

66 May be performed only by PTs with ABPTS certification and certification in this specific procedure, or performed personally by the physician.

77 PT with ABPTS certification (TC & PC), or direct supervision of physician (TC & PC), or technician with certification and general supervision of physician (TC only; PC physician) procedure.

22 May be performed by a technician with on-line real-time contact with physician

21 Procedure may be performed by technician with certification and under general supervision of a physician; otherwise under direct supervision of physician. (TC only; PC always physician).

NEUROLOGY AND NEUROMUSCULAR PROCEDURES

SLEEP TESTING

95805 & TC

1

95806 & TC

1

95807 & TC

1

95808 & TC

1

95810 & TC

1

95811 & TC

1

95812 & TC

1

95813 & TC

1

95816 & TC

1

95819 & TC

1

95822 & TC

1

95824 & TC

1

95827 & TC

1

95829 & TC

1

95858 & TC

3

95860 & TC

6a

95861 & TC

6a

95863 & TC

6a

95864 & TC

6a

95867 & TC

6a

95868 & TC

6a

95869 & TC

6a

95870 & TC

6a

95872 & TC

66

95875 & TC

3

95900 & TC

77a

95903 & TC

77a

95904 & TC

77a

95920 & TC

22

95921 & TC

2

95922 & TC

3

95923 & TC

3

95925 & TC

21

95926 & TC

21

95927 & TC

21

95930 & TC

21

95933 & TC

77a

95934 & TC

77a

95936 & TC

77a

59937 & TC

77a

95950 & TC

1

95951 & TC

1

95953 & TC

1

95954 & TC

3

95955 & TC

2

95956 & TC

1

95957 & TC

1

95958 & TC

3

95961 & TC

3

95962 & TC

3

   

CENTRAL NERVOUS SYSTEM ASSESSMENT

96100

4

96105

4

96110

4

96111

4

96115

4

96117

4

ALPHA-NUMERICS

G0004

1

G0005

1

G0006

1

G0015

1

G0030 & TC

1

G0031 & TC

1

G0032 & TC

1

G0033 & TC

1

G0034 & TC

1

G0035 & TC

1

G0036 & TC

1

G0037 & TC

1

G0038 & TC

1

G0039 & TC

1

G0040 & TC

1

G0041 & TC

1

G0042 & TC

1

G0043 & TC

1

G0044 & TC

1

G0045 & TC

1

G0046 & TC

1

G0047 & TC

1

G0050

1

G0106 & TC

3

G0125 & TC

1

G0126 & TC

1

G0130 & TC

1

G0131 & TC

1

G0132 & TC

1

G0163 & TC

1

G0164 & TC

1

G0165 & TC

1

M0302 & TC

1

Q0035 & TC

1

V5362

1

V5363

1

V5364

1

       
This page was last updated on 09/09/03
 


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