wendya
Contributor
We have a wound care client who is sending an LPN to patients’ homes to perform CPT 97610 (UltraMist ultrasound treatment) under Virtual Direct Supervision from a provider. Their healthcare attorney has reviewed the model and signed off on it.
However, our Medicare specialist is concerned because she views Virtual Direct Supervision as falling under telehealth, and since CPT 97610 is not on Medicare’s telehealth approved list, she believes the service would not be allowed in this setup.
The client’s position is that because CPT 97610 has a PC/TC indicator of “0,” they can bill it incident-to using Virtual Direct Supervision.
Here’s the piece of CMS guidance that’s adding to the confusion:
In the CY 2025 PFS Final Rule, CMS finalized a permanent (but more limited) policy starting January 1, 2026, allowing Virtual Direct Supervision for incident-to services only when:
• Indicator 0 applies to services like active wound care procedures, where the full payment is for the integrated service, often allowing incident-to billing by auxiliary personnel under supervision without splitting.
The CY 2026 Medicare Physician Fee Schedule (PFS) final rule makes virtual direct supervision permanent for most incident-to services, effective January 1, 2026. This includes general incident-to services under 42 CFR § 410.26 (like CPT 97610 furnished by an LPN under a midlevel provider’s supervision), as long as the service does not have a global surgery indicator of 010 or 090 (97610 does not). The virtual supervision must use real-time audio-video technology (audio-only is excluded), and all other incident-to requirements must be met.
So the two big questions I’m hoping the group can help with are:
Thanks
Wendy
However, our Medicare specialist is concerned because she views Virtual Direct Supervision as falling under telehealth, and since CPT 97610 is not on Medicare’s telehealth approved list, she believes the service would not be allowed in this setup.
The client’s position is that because CPT 97610 has a PC/TC indicator of “0,” they can bill it incident-to using Virtual Direct Supervision.
Here’s the piece of CMS guidance that’s adding to the confusion:
In the CY 2025 PFS Final Rule, CMS finalized a permanent (but more limited) policy starting January 1, 2026, allowing Virtual Direct Supervision for incident-to services only when:
- The service is furnished by auxiliary personnel employed by the supervising provider, and
- The HCPCS code has a PC/TC indicator of “5.”
• Indicator 0 applies to services like active wound care procedures, where the full payment is for the integrated service, often allowing incident-to billing by auxiliary personnel under supervision without splitting.
The CY 2026 Medicare Physician Fee Schedule (PFS) final rule makes virtual direct supervision permanent for most incident-to services, effective January 1, 2026. This includes general incident-to services under 42 CFR § 410.26 (like CPT 97610 furnished by an LPN under a midlevel provider’s supervision), as long as the service does not have a global surgery indicator of 010 or 090 (97610 does not). The virtual supervision must use real-time audio-video technology (audio-only is excluded), and all other incident-to requirements must be met.
So the two big questions I’m hoping the group can help with are:
- Does Virtual Direct Supervision fall under telehealth rules for coverage and billing?
- If not, does a PC/TC of “0” still allow for incident-to billing when using Virtual Direct Supervision?
Thanks
Wendy
