Covered services provided for members must be personally performed by an eligible professional provider, or under the provider's direct personal supervision.
The following providers are eligible when, duly licensed and acting within the authority of their licenses:
- Audiologists
- Certified registered nurses
- Certified registered nurse anesthetists
- Certified registered nurse practitioners
- Certified enterostomal therapy nurses
- Certified community health nurses
- Certified psychiatric mental health nurses
- Certified clinical nurse specialists
- Clinical laboratories
- Dentists
- Doctors of chiropractic
- Doctors of medicine
- Doctors of osteopathy
- Nurse midwives
- Optometrists
- Physical therapists
- Podiatrists
- Psychologists
- Speech pathologists
- Teachers of the hearing impaired
Covered services performed under the personal supervision of an eligible provider by a licensed health care practitioner (e.g., physician's assistant, licensed clinical social worker, and registered physical therapy assistant) in his or her employment may be eligible. (See Medical Policy Bulletin Z-33 for information on employment relationship criteria. See Medical Policy Bulletin Z-10 for information on physician's assistants. See Medical Policy Bulletin Y-1 for information on physical medicine.)
"Personal supervision" means that the provider must be in the immediate vicinity so that he or she can personally assist in the procedure, or to assume primary care of the patient, if necessary. Such services are eligible only if the criteria of appropriate licensure, employment, and supervision are met. (See Medical Policy Bulletin A-3 for additional information on supervision of anesthesia services.)
Availability of the provider by telephone does not constitute direct personal supervision.
Certain diagnostic tests have been identified that have extended technical components wherein the patient goes about normal daily activities while being monitored. These tests include holter monitoring (93224, 93230, 93235), cardiac event monitoring (93268), and sleep studies (95807-95811). These procedures are performed under the physician's overall management and control, but the physician is not present for the duration of the test.
- NOTE:
- There may be exceptions to this policy depending on the individual member's contract, and provider network rules.
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