In its 2019 Medicare Physician Fee Schedule Final Rule (PFS Rule), CMS finalized a regulatory change that updates supervision requirements for Registered Radiologist Assistants and Radiology Practitioner Assistants (collectively, RAs) to reduce the level of supervision necessary to perform diagnostic tests reimbursable by Medicare. Specifically, the PFS Rule revises 42 C.F.R. § 410.32(b) to provide that RAs may perform certain diagnostic tests that would otherwise require a personal level of supervision under direct supervision instead, to the extent permitted by state law and regulations.

Under Medicare regulations, “personal supervision” requires the supervising physician to be in the same room during the performance of the procedure, whereas “direct supervision” requires the supervising physician to be present in the same office suite and immediately available to furnish assistance and direction during the performance of the procedure.

This change, which was made in response to recommendations of the practitioner community, does not affect the supervision requirements for procedures that currently require “general supervision” by a physician. General supervision requires a physician to maintain “overall direction and control” over a procedure, but the physician is not required to be present during the actual performance of the procedure. In the PFS Rule, CMS also noted that 28 states recognize Radiologist Assistants, and these states have general or direct supervision requirements for the practice of Radiologist Assistants. The new supervision requirements take effect January 1, 2019.

This post is part of a series analyzing changes in the 2019 PFS Final Rule; please see here for other posts related to the PFS Final Rule.


This post was co-authored by Alyssa Ferreone, legal intern at Robinson+Cole. Alyssa is not yet admitted to practice law.