Highmark Medical Policy Bulletin
Section: Miscellaneous
Number: Z-27
Topic: Supervision Guidelines
Effective Date: April 1, 2003
Issued Date: July 26, 2004
Date Last Reviewed: 11/2003

General Policy Guidelines

Indications and Limitations of Coverage

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
  • Certain certified registered nurses
  • 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 therapy.)

"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.

Procedure Codes


Traditional (UCR/Fee Schedule) Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

Comprehensive / Wraparound / PPO / Major Medical Guidelines

Refer to General Policy Guidelines

Any reference in this bulletin to non-billable services by a network provider may not be applicable to Major Medical.

Managed Care (HMO/POS) Guidelines

Refer to General Policy Guidelines

Publications

PRN References

06/1994, New providers now eligible to participate with Blue Shield
10/1994, Supervision guidelines
08/1995, Massage therapists' services
08/1999, Chiropractic assistants' services not covered
10/1999, Certified Registered Nurses
10/1999, Physician Assistants
04/2000, Eligibility requirements for supportive personnel

References

View Previous Versions

[Version 005 of Z-27]
[Version 004 of Z-27]
[Version 003 of Z-27]
[Version 002 of Z-27]
[Version 001 of Z-27]

Table Attachment

Text Attachment

Procedure Code Attachment


Glossary




Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.