Physician Supervision of Diagnostic Procedures within an Office Setting The Health Care Financing Administration revised the levels of physician supervision required for diagnostic testing performed in a physician office by non-physician personnel. More than 750 diagnostic tests are affected by this requirement. Non-physician practitioners include physical therapists, registered nurses, audiologists, medical assistants, and clinical psychologists.   The three major categories of physician supervision include General, Direct, or Personal.   Level 1: General Supervision General supervision includes the attending physician's overall direction and control of the training, and equipment, but the physician's presence is not required during the diagnostic procedure. The physician does not have to be present when the service is performed.   Level 2: Direct Supervision Direct supervision in an office setting includes the physical presence of the physician within the office suite, and immediate availability throughout the diagnostic procedure. The physician must be present in the suite, but not in the room when the service is performed.   Level 3: Personal Supervision Personal supervision requires the physician to be present in the room during the procedure.   These regulations become effective July 1, 2001. The regulation does not affect diagnostic procedures for hospitalized patients, diagnostic lab tests, or diagnostic FDA regulated mammograms. The supervision requirements for the Clinical Lab Improvement Act (CLIA) remain in effect.   The transmittal has been made available to all clinical departments. Further information will be provided, as it becomes published. The Office for Billing Compliance is also available for detailed information.   Return to Contents | Return to Billing Compliance