Among the various regulatory topics addressed in the CY 2022 Medicare Physician Fee Schedule (PFS) final rule was the manner in which a physician or other practitioner can meet the supervision requirements for those diagnostic tests that require "direct" supervision. Those tests generally include MRI and CT scans where contrast media is administered. 

During the public health emergency (PHE), CMS amended its supervision rules to require that until the latter of the end of the calendar year in which the PHE ends or December 31, 2021, the presence of the supervising physician/practitioner can be via virtual presence through audio/video real-time communications technology (excluding audio-only). As we discussed previously, CMS requested comments in the proposed PFS rule on whether it should make this a permanent change.

In the final rule, CMS acknowledged receipt of comments recommending that CMS permanently modify the definition of direct supervision to include the virtual presence of the supervising practitioner. But the Medicare agency has deferred making any changes yet to these requirements and indicated that the agency will consider addressing the issue in future rules or guidance, as appropriate.

In October, the PHE determination was continued. The renewed declaration will last for 90 days through January 16, 2022. This means that the ability to make use of audio/video real-time communications technology to perform direct supervision of contrast studies continues at least until the end of 2022.  The question is whether it will eventually become a permanent rule.

We can expect CMS to address the use of virtual presence when performing direct supervision again in the CY 2023 proposed PFS rule when it is published next summer. Stay tuned.