Medicare has permanently expanded the definition of direct supervision for incident-to services, allowing supervising physicians to be virtually present rather than physically in the office suite. This major shift updates rules that had been in place for decades and affects billing, revenue, and workflow.

What Practices Need to Know

• Virtual supervision now applies to most incident-to services, including 99211 visits and procedures without global surgery indicators 010 or 090
• Supervising providers must remain immediately available for patient care; virtual presence does not replace clinical judgment or readiness
• Some services previously billed directly by NPs or PAs can now be reported incident-to at the physician rate, potentially impacting revenue

Best Practices for Compliance

• Update internal policies to reflect the expanded supervision rules
• Educate staff on which services qualify for virtual supervision
• Remember that new patient restrictions, plan-of-care requirements, and other CPT® criteria still apply

🔍 Audit Takeaway

The shift to virtual supervision provides flexibility and greater access to care—but success depends on clear policies, staff training, and careful application of clinical judgment. Staying proactive ensures compliance and smooth billing under the new rules.

Each Auditor Insight is inspired by trends our auditing team sees in practice or by industry developments with meaningful implications for coding, documentation, and compliance. Our goal is to help organizations stay informed, reduce risk, and code with confidence.

Resources: 

• Anesthesia and Pain Coder’s Pink Sheet 

• 42 CFR §410.26 

• 42 CFR §410.32