Hospital Outpatient Therapeutic Services – Change in Supervision Level

For all hospital outpatient therapeutic services furnished prior to January 1, 2020 with the exception of non‐surgical extended duration services (NSEDTS), Medicare required direct supervision unless CMS assigned a supervision level of either general or personal supervision for an individual service. Effective January 1, 2020, the default minimum level of supervision for hospital outpatient therapeutic services changed to general supervision for all services except for NSEDTS, pulmonary rehabilitation services, cardiac rehabilitation services, and intensive cardiac rehabilitation services. Except as described at the weblink below, NSEDTS continue to have a hybrid level of supervision. See 42 CFR 410.27(a)(1)(iv)(E) for a description of NSEDTS. Similarly, except as described in the weblink below, pulmonary rehabilitation, cardiac rehabilitation, and intensive cardiac rehabilitation services continue to require direct supervision by a doctor of medicine or osteopathy. See 42 CFR 410.27(a)(1)(iv)(D).  Click on the weblink below for the full guidelines and revisions to the supervision level.