As most you have read, yesterday (January 30, 2023) the Biden Administration announced plans to end the COVID-19 public health emergency (PHE) on May 11, 2023. For diagnostic imaging providers, this announcement requires consideration and planning for the possible end of virtual supervision of imaging studies with contrast. But CMS has left the door open to extend this approach to supervision.

During the public health emergency, CMS amended its supervision rules to allow that until the last day of the calendar year in which the PHE ends (likely now December 31, 2023), the supervising physician/practitioner for Level 2 tests using contrast media could be virtually present throughout the performance of the test - as opposed to being physically on site  -  via audio/video real-time communications technology (excluding audio-only).

Last summer, CMS had requested comments as to whether they should permanently modify the definition of direct supervision to permit on an ongoing basis this virtual presence when it published the proposed Medicare Physician Fee Schedule (MPFS) rule for CY 2023. But in its final MPFS 2023 rule, the Medicare agency deferred making any changes to these requirements.

CMS announced in the 2023 final rule that it planned to continue gathering information on this topic. The agency indicated that it believes allowing additional time to collect information and evidence regarding direct supervision through real time virtual presence will help it to better understand the potential circumstances in which this flexibility could be appropriate on a permanent basis, outside of the PHE for COVID-19. CMS wants to address the impact of a permanent change on patient safety.

We should expect CMS to address the question of making permanent the ability to perform direct supervision virtually using audio/video communications technology again in the CY 2024 proposed PFS rule when it is published this summer. No doubt many stakeholders in the diagnostic imaging industry will urge CMS to make virtual supervision a permanent fixture of the Medicare rules. Those comments may also contain recommendations as to what kind of auxiliary medical personnel could be on hand to respond to contrast reactions when the supervising physician/practitioner is only virtually present.

We will be watching this rule making very closely!