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Cardiology Coding Alert

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Master Medicare Supervision Levels

Published on Thu Jun 22, 2006

Question: Would you explain the "physician supervision of diagnostic services" section of Medicare's Fee Schedule?

New Hampshire Subscriber

Answer: The Medicare Fee Schedule supervision indicators show the level of physician supervision required for a diagnostic test if it's performed in a physician office, imaging center, or independent diagnostic facility (IDTF). Important: These rules don't apply to diagnostic tests performed in an inpatient or outpatient hospital setting.
 
Level 01 is general supervision. The physician provides direction and control during the procedure, but the service doesn't require the physician's presence. Examples include plain films, most ultrasounds, and CT or MRI without contrast.
 
Level 02 is direct supervision. The physician must be present in the office suite and immediately available to furnish assistance and direction. The physician does not have to be in the room where the cardiologist performs the test, however. Examples include exams using intravenous contrast and cardiovascular stress tests.
 
Level 03 is personal supervision. The physician must be in attendance in the room during the procedure. Examples include heart catheterizations and transesophageal echocardiogram.
 
Level 09 is "concept does not apply."
 
Protect yourself: Check payer policy information, CPT guidelines and fee schedule data to determine what level of supervision your payer requires for  each code.

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