For starters, it must be performed under your direct supervision.
The reimbursement for a visual field or any other test includes the set-up, instruction and performance of the test, whether performed by a physician or a technician. However, if the physician orders the patient to return for a test and visit with a technician, then 99211 might be appropriate if there is medical necessity to do so.
Q. How is a technician visit defined?
A. CPT defines a technician visit as 99211 “Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional.”
Q. What supervision is required?
A. Because the service is being performed by the doctor’s auxiliary personnel and is an incidental part of a physician service, it must be performed under direct supervision as discussed in the Medicare Benefit Policy Manual, Chapter 15, §60.2:
“In addition to coverage being available for the services of such auxiliary personnel as nurses, technicians, and therapists when furnished incident to the professional services of a physician, a physician may also have the services of certain nonphysician practitioners covered as services incident to a physician’s professional services.” Nonphysician practitioners include physician assistants, nurse practitioner, and clinical nurse specialists as well as certified nurse midwives, clinical psychologists and clinical social workers.
For coverage instructions for various allied health/nonphysician practitioners’ services, see §§150 through 200:
“Services performed by these nonphysician practitioners incident to a physician’s professional services include not only services ordinarily rendered by a physician’s office staff person (eg, medical services such as taking blood pressures and temperatures, giving injection, and changing dressings) but also services ordinarily performed by the physician himself or herself such as minor surgery, setting casts or simple fractures, reading x-rays, and other activities that involve evaluation or treatment of a patient’s condition.”
The Medicare Benefit Policy Manual further explains that in order for services of a nonphysician practitioner to be covered as incident to the services of a physician, the services must meet all of the requirements specified in §§60 through 60.1. That is, “the services must be an integral, although incidental, part of the physician’s personal professional services, and they must be performed under the physician’s direct supervision.”
Q. What does “direct supervision” mean?
A. Direct supervision in the office setting does not mean that the physician must be present in the same room with the technician. However, the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the technician is performing services.
Q. What documentation is required?
A. First, a physician must order the technician visit and specify what is to be done. Then, to support the claim, the technician should document the visit in the chart in the form of a S-O-A-P note. That is:
- Subjective complaint — ie, patient presents for glaucoma follow-up and visual field testing as directed by Dr. X
- Objective findings — visual acuity, tonometry and, depending on the skill level of the tech, possibly a slit lamp exam
- Assessment — change to vision or IOP since last visit; ie, stable since last visit
- Plan — based on the direction from the physician’s prior order for the visit, the patient should continue on medications, return to office for follow-up, expect a call from the physician, etc.
The physician must promptly review the technician’s notes and sign off on the exam, indicating concurrence and approval.
The technician cannot change medications or instruct the patient to follow a different regimen than prescribed by the physician. If the patient presents with an elevation to his or her IOP or a decrease to vision, the plan should state, “see Dr. X.”
Q. What does Medicare allow for 99211?
A. The 2019 national Medicare allowable for 99211 is $23.07. This amount is adjusted in each locality. OM