CMS Pub. 100-02, ch. 6, § 20.5.3

Physician’s Service Furnished on or After January 1, 2020 – Changes to

Supervision Requirements

(Rev. 10541; Issued: 12-31-20; Effective: 01-01-21; Implementation: 01-04-21)

Starting January 1, 2020, CMS requires, as the minimum level of supervision, general

supervision by an appropriate physician or non-physician practitioner in the provision of

all therapeutic services to hospital outpatients, including CAH outpatients. “General

supervision” means the definition specified at 42 CFR 410.32(b)(3)(i), that is, the

procedure or service is furnished under the physician's overall direction and control, but

the physician's presence is not required during the performance of the procedure. CMS

may assign certain hospital outpatient therapeutic services either direct supervision or

personal supervision. When such assignment is made, “direct supervision” means the

definition specified at 42 CFR 410.32(b)(3)(ii), that is, the physician must be

immediately available to furnish assistance and direction throughout the performance of

the procedure. It does not mean that the physician or must be present in the room when

the procedure is performed. “Personal supervision” means the definition specified at 42

CFR 410.32(b)(3)(iii), that is, the physician must be in attendance in the room during the

performance of the service or procedure.

The list of services starting January 1, 2020 and ending December 31, 2020 that are

defined as non-surgical extended duration therapeutic services where the initiation of the

service must be performed under direct supervision is available on the OPPS Website at

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/HospitalOutpatientPPS/index.html. Starting January 1, 2021, the minimum level

of supervision for non-surgical extended duration therapeutic services will be general

supervision for the entire service including for the initiation of the service.

20.5.4 - Coverage of Outpatient Therapeutic Services Incident to a

Physician’s Service Furnished on or After January 1, 2024 – Changes to

Direct Supervision Requirements for Pulmonary, Cardiac and Intensive

Cardiac Rehabilitation

(Rev. 12421; Issued: 12-21-23; Effective: 01-01-24: Implementation: 01-02-24)

Beginning January 1, 2024, the required direct supervision of pulmonary rehabilitation

services, as specified at 42 CFR 410.47, and cardiac rehabilitation and intensive cardiac

rehabilitation services, as specified at 42 CFR 410.49, may be furnished by a doctor of

medicine, a doctor of osteopathy, a physician assistant, a nurse practitioner, or a clinical

nurse specialist.