May 07, 2020

CMS Gives Flexibilities and Guidance During COVID-19

On April 30, the Centers for Medicare and Medicaid Services (CMS) released an additional Interim Final Rule with comment period (IFC) granting flexibilities and guidance during the COVID-19 public health emergency (PHE). The IFC included changes to Medicare supervision rules for diagnostic tests.

CMS is finalizing changes to add flexibility on an interim basis for nurse practitioners, clinical nurse specialists, physician assistants and certified nurse-midwives. Under CMS policy, only physicians are generally permitted to supervise diagnostic tests.

CMS will permit, on an interim basis, non-physician practitioners (NPPs) to furnish services that would typically be physician services. They include professional services NPPs furnish directly and “incident to” their own professional services, to the extent authorized under their state scope-of-practice statutes and regulations. This interim change will allow these practitioners to order, furnish directly and supervise the performance of diagnostic tests, subject to applicable state law during the PHE.

CMS is seeking input about several states that have scope-of-practice rules that are more flexible than allowed by federal regulations.

The ACR staff are closely tracking state orders on scope related matters during the pandemic to help ensure appropriate safeguards to help protect the public are observed during this crisis, and that any such relaxation of quality/safety standards be rescinded once the crisis has abated.

The IFC also included additional flexibilities and clarifications on billing of evaluation and management services conducted by telephone, hospital outpatient services furnished at temporary expansion locations, updates to the hospital value-based purchasing program, the Medicare Shared Savings Program, the Merit-based Incentive Payment System and Qualified Clinical Data Registry measure approval criteria.

The American College of Radiology® has prepared a detailed summary of the IFC. Questions about the COVID-19 IFC should be directed to