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Ob-Gyn Coding Alert

Reader Questions:

Master Medicare Supervision Levels

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 testing 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 overall direction and control, but the service doesn't require the physician's presence during the procedure. This means that the physician is responsible for making sure the person performing the procedure and/or interpreting the result has had sufficient training to do so.
Further, the physician should make sure the equipment the technician uses to perform the procedure is being properly maintained. A fetal non-stress test, for instance, only requires general supervision.
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 technician performs the test, however. An example is monthly Depo-Provera injections.
Level 03 is personal supervision. The physician must be in attendance in the room during the procedure. For instance, hysterosalpingography (74740) requires the physician's presence during the procedure.
Level 09 is -concept does not apply.-
Protect yourself: Check payer policy information, CPT guidelines and fee schedule data to determine what supervision level your payer requires for each code.