The 2026 Medicare Physician Fee Schedule (MPFS) permanently establishes a popular provision set to expire at the end of 2025. The MPFS confirms “virtual direct supervision,” originally established in 2020 and extended annually by MPFS Final Rules through 2025, is no longer an interim policy as of January 1, 2026.
Medicare Direct Supervision
Under Medicare Part B, some diagnostic tests and “incident-to” services require direct (level 2) supervision. Historically, providers have had to be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the service; however, they do not have to be present in the room.
In March of 2020 the definition of “direct supervision” was amended to include a “virtual” presence using two-way, real-time audio/visual (video) communications technology. Providers were not required to have a real-time presence or observation of the service throughout the performance of the service, and this policy was extended in the CY 2021, 2024, and 2025 MPFS Final Rules through December 31, 2025.
CMS is permanently adopting a definition of direct supervision that allows “immediate availability” of the supervising practitioner using audio/video real-time communications technology (excluding audio-only) for all services described under § 410.26, except for services that have a global surgery indicator of 010 or 090.
Procedures that are excluded include:
- Minor procedures with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period included in the fee schedule amount.
- Evaluation and management services on the day of the procedure and during this 10-day postoperative period.
- Major surgery with a one-day preoperative period and a 90-day postoperative period included in the fee schedule payment.
CMS is also seeking comments on whether services with a 000 global surgery indicator should also be excluded.
Incident To Services
“Incident To” services are submitted under the physician’s NPI but are performed by a non-physician practitioner (NPP) or mid-level and are most commonly provided in a physician’s office. These services cannot be rendered on the patient’s first visit, or if a change to the plan of care occurs; however, after the encounter where the physician establishes a diagnosis and initiates the plan of care, an NPP or mid-level may provide follow-up care under the “direct supervision” of a qualified provider.
For a deeper dive into all changes finalized in the 2026 Medicare Physician Fee Schedule, including conversion factor updates, quality program changes, and the full set of RVU adjustments, visit our comprehensive summary: A Summary of the 2026 Medicare Physician Fee Schedule Final Rule
Barbara Rubel
MBA, FRBMA
Senior Vice President, Marketing & Client Services
Barbara has been a leader with MSN Client Services since 1998. Her extensive background in strategic planning, market research, healthcare marketing and managed care negotiations provides a wealth of information to support MSN Clients.
Barbara has also been highly involved in industry organizations, serving as President of the Radiology Business Management Association (RBMA), the Georgia RBMA, and the Florida RBMA. In addition, she chaired the influential RBMA Federal Affairs Committee and the RBMA Technology Task force and was a member of the RBMA Data Committee. Her work on behalf of radiology has earned her the RBMA Special Recognition Award (2010), the RBMA Global Achievement Award (2013), and she is a Fellow of the RBMA.
