Incident ToSupervision Requirements Vary by Code

According to the Medicare Carriers Manual (MCM), nonphysician practitioner (NPP) services provided incident to physician services must occur under the direct supervision of the physician under whose personal identification number (PIN) the service is provided. This requires that the physician be present in the office suite and readily accessible at all times. Later CMS memoranda allow for varying supervision requirements for some diagnostic tests, however.
In addition to direct supervision, CMS guidelines allow for either general or personal supervision of certain diagnostic tests. General supervision requires that the physician be available for consultation, but he or she need not be in the office suite. Personal supervision requires that the physician be in the same room as the NPP and patient. Note that direct or personal supervision is required for all allergy tests due to the possibility of (a potentially life-threatening) anaphylactic reaction.
According to CMS Program Memorandum B-01-28 (April 19, 2001), the following diagnostic tests, when performed by an NPP, require direct physician supervision:
95004 Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, specify number of tests
95024 Intracutaneous (intradermal) tests with
allergenic extracts, immediate type reaction, specify number of tests
95027 Skin end point titration
95028 Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests
95044 Patch or application test(s) (specify number of tests)
95052 Photo patch test(s) (specify number of tests)
95056 Photo tests.
Due to increased risk to the patient, the following diagnostic services must be performed under the personal supervision of a physician:
95060 Ophthalmic mucous membrane tests
95070 Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with histamine, methacholine, or similar compounds
95071 with antigens or gases, specify
95075 Ingestion challenge test (sequential and incremental ingestion of test items, e.g., food, drug or other substance such as metabisulfite)
95078 Provocative testing (e.g., Rinkel test).
Documentation must substantiate that the physician was in the room and immediately available if any of the above codes are to be reported incident to.
Note: Any codes specifically covered in memo B-01-28 are covered by standing Medicare policy as dictated by the MCM (i.e., direct physician supervision is required).
Local Medicare carriers must apply CMS guidelines as required by memo B-01-28 and the MCM unless state scope-of-practice laws or regulations allow different criteria for NPPs providing such testing. The Code of Federal Regulations specifies, "Nonphysician practitioners (that is, clinical nurse specialists, clinical psychologists, clinical social workers, nurse-midwives, nurse practitioners, and physician assistants) who furnish services that would be physician services if furnished by a physician, [...]

- Published on 2002-06-01