The Centers for Medicare & Medicaid Services (CMS) has just issued a proposed rule that announces and solicits public comments on proposed policy changes for payments under the Medicare Physician Fee Schedule (MPFS) effective on or after January 1, 2025. Diagnostic imaging stakeholders will be disappointed by yet another reimbursement cut, this year 2.8 %, and heartened by CMS's decision to accept screening computed tomography colonography coverage.

One eagerly awaited proposal was the question whether CMS would extend authority for physician offices and independent diagnostic testing facilities (IDTFs) to directly supervise certain diagnostic tests via real-time audio and visual interactive telecommunications technology. They have done so, but only for one year through December 31, 2025. The can is kicked down the road once again.

CMS has proposed, for a certain subset of services that are required to be furnished under the direct supervision of a physician or other supervising practitioner, to permanently adopt a definition of direct supervision that allows the physician or supervising practitioner to provide such supervision through real-time audio and visual interactive telecommunications. They are specifically proposing that the physician or supervising practitioner may provide such virtual direct supervision for services furnished “incident to” a physician’s service. 

But for all other services, principally radiology studies with contrast media furnished under the direct supervision of the supervising physician or other practitioner, CMS has proposed to continue to define “immediate availability” to include real-time audio and visual interactive telecommunications technology only through December 31, 2025. Currently virtual direct supervision of Level 2 radiology tests - MRI and CT with contrast media -  is in place only until the end of this year, December 31, 2024.

Even with the one-year extension, the failure of CMS to make virtual supervision permanent is certainly disappointing. Especially given the record of safety and efficacy of virtual supervision to date. For now, the industry is unfortunately left with uncertainty about long-time reliance on this supervision model. 

Unless CMS accepts recommendations that can be expected from the diagnostic imaging community for the need to make virtual supervision permanent, the use of virtual supervision in IDTFs and physician offices appears destined to retain a sunset date, albeit one year beyond the current end date.