I am in a small group (2 of us) and we always mix our allergy serum at one site. When one of us goes on vacation we are uncertain if a trained LPN can continue to mix without the other physician being in the building but rather being available a few miles away in case of questions. We are aware of the Medicare policy stating there needs to be a physician readily available and nearby, basically in the same office. However, are we out of line if we mix serum from other insurance companies when a supervisor is not in the same building? It is quite a nuisance to switch all the patients so we are in the same office together and therefore I am looking to see if this is allowed. I keep looking and getting the vague response that Medicare requires this, but then does it definitely apply to other insurance companies.


Normally, this website does not answer questions regarding billing, coding, or other financial issues. The Joint Council of Allergy, Asthma, and Immunology is the proper source to handle such inquiries. For your convenience, I am supplying here the contact information of the Joint Council:

50 North Brockway
Palatine, Illinois 60067

E-mail JCAAI at: info@jcaai.org

Website: www.jcaai.org

However, here is another website which deals with billing and coding and their statement about whether or not a supervising physician needs to be present on the premises during allergen preparation. I think this is self-explanatory.

Note the Supervising Physician
Most important, your practice needs to follow Medicare's direct-supervision requirements for 95165. In contrast, the OIG's survey found that many FPs were billing for antigen preparation services performed in the absence of the supervising physician. If an auxiliary staff member, such as a registered nurse or technician, prepares the antigens, the FP must provide direct personal supervision of the services for the employee to bill 95165 incident-to the physician based on Medicare incident-to rules, Cobuzzi says.

Direct supervision does not mean that the FP must be in the same room when an NPP or aide prepares the antigens. But the physician must be present in the office suite and immediately available to provide direction and assistance throughout the time the staff person is performing the service, according to the Medicare Carriers Manual sections 2050.1-2050.2.

To substantiate that your office meets the supervision requirements, Empire Medicare suggests that whenever you bill services incident-to a physician, you should note that "Dr. Smith is here supervising," Cobuzzi says. "That way, Medicare doesn't have to go through your appointment books to make sure the doctor is present during the hours the technician is mixing the antigens."

Unfortunately, I am only aware of one way for you to find out whether any individual commercial company insists on the same requirements, and that is to contact each company separately. This of course would need to be done by your office because there are regional differences in coverage policies, especially with Blue Cross.

In summary, as you can see from the statement copied above, Medicare does have a requirement that a supervising physician be present. If you need further information regarding this issue, the Joint Council would be your proper source to contact. As far as other carriers, I think the only option would be to contact them individually to see if you can obtain the regulations that they use regarding this issue; that is, unless the Joint Council has further information in this regard.

Thank you again for your inquiry and we hope this response is helpful to you.

Phil Lieberman, M.D.

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