The Centers for Medicare and Medicaid Services (CMS) provided further clarification on the existing physician supervision regulation that affects diagnostic and therapeutic services, including radiation oncology and interventional radiology services in the 2010 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule released on July 1, 2009.
CMS proposed not to allow non-physician practitioners (physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse mid-wives) to provide supervision of diagnostic tests in hospital settings. Supervision for diagnostic tests must be furnished by a physician (doctor of medicine or osteopathy, dental surgery or medicine, doctor of podiatric medicine, doctor of optometry and chiropractor). Clinical psychologists are allowed to supervise only diagnostic psychological and neuropsychological tests. Supervising physicians in hospital settings are expected to follow the supervision levels for individual diagnostic tests listed the Medicare Physician Fee Schedule (MPFS) Relative Value Unit (RVU) file.
Regarding therapeutic services, currently, the role of supervising therapeutic services is reserved for physicians (doctor of medicine or osteopathy, dental medicine, podiatric medicine, optometry, and chiropractor). CMS proposes to allow non-physician practitioners (nurse practitioners, physician assistants, certified nurse-midwives, and clinical nurse specialists) to supervise all hospital therapeutic services that they may perform themselves in accordance with their state law and scope of practice and hospital-granted privileges.
CMS also redefined what direct supervision means for therapeutic services by stating “direct supervision means that the supervisory physician or non-physician practitioner must be present on the same campus, in the hospital or the on-campus provider-based department (PBD) of the hospital as defined in §413.65, and immediately available to furnish assistance and direction throughout the performance of the procedure.”
Furthermore, CMS defined the term “in the hospital” to mean “areas in the main building(s) of a hospital that are under the ownership, financial, and administrative control of the hospital; that are operated as part of the hospital; and for which the hospital bills the services furnished under the hospital’s CMS certification number (CCN). CMS clearly stated that the supervising physicians and non-physician practitioners must be physically present in the areas of the campus of the hospital where the services furnished during the performance of the procedure. It is also not permissible to allow supervising physicians and non-physician practitioners to supervise procedures that are being performed at off-campus locations.
CMS explained that the term “immediately available” for supervision purposes to mean being available “without interval of time.” Consequently, supervising physicians and non-physician practitioners are expected not to be engaged in another procedure that they could not be interrupted from or not to be physically far away on the campus in order to be able to intervene without delay.
Comments on the supervision regulation and the rest of CY 2010 HOPPS proposed rule are due on August 31, 2009.
For more information: www.acr.org
April 15, 2026 
