Good news for allergy practices: virtual direct supervision is now permanent under Medicare for many allergy services. As announced in the 2026 Medicare Physician Fee Schedule final rule, physicians can meet the “direct supervision” requirement using real-time audio/video technology instead of being physically present in the office for many services.
What “direct supervision” means
Under Medicare “incident to” billing rules, services performed by clinical staff must be directly supervised by a physician or other qualified practitioner. Historically, direct supervision meant the supervising physician had to be physically present in the office suite and immediately available.
During the COVID-19 public health emergency, CMS temporarily allowed immediate availability and physical presence to be met using real-time audio/video technology. The 2026 rule makes this flexibility permanent for most services.
Under the new rule, direct supervision can be met if the supervising practitioner is:
- Immediately available
- Connected through real-time audio/video technology
- Not using audio-only communication
This means the supervising physician can be available virtually rather than physically onsite, as long as they are immediately available to provide direction and assistance.
Allergy services that may use virtual direct supervision
Several commonly performed allergy services fall under this updated definition when they are provided “incident to” a physician’s services.
Examples include:
| CPT Code | Service |
|---|---|
| 95165 | Preparation and provision of antigens for allergy immunotherapy |
| 95115 / 95117 | Allergen immunotherapy injections (single or multiple) |
| 94010 | Spirometry |
| 95004 | Percutaneous allergy testing (scratch, prick, puncture) |
| 95017 | Venom testing |
| 95044 | Patch testing |
| 95076/95079 | Oral ingestion challenge testing (initial 120 minutes and each additional 60 minutes) |
| 95180 | Rapid desensitization procedure |
| 96372 | Therapeutic injection |
These services may now be supervised virtually using real-time audio/video technology, provided all other Medicare “incident to” requirements are met.
Risks and considerations for remote supervision
While the policy offers helpful flexibility, practices should carefully consider the clinical and legal responsibilities associated with remote supervision.
- Practices should review state scope-of-practice laws to ensure clinical staff are permitted to perform these services. Rules governing what registered nurses (RNs), licensed vocational/practical nurses (LVNs/LPNs), and medical assistants (MAs) may do are outlined at the state level and may affect whether certain tests, injections, or procedures can be delegated.
- Staff must be well trained. Clinical staff performing skin testing, immunotherapy injections, or challenge procedures must be competent and skilled in these services and in recognizing and managing complications, including anaphylaxis.
- Emergency preparedness is essential. Offices should have clear protocols, medications (such as epinephrine), and trained personnel available to respond to adverse reactions.
- The physician remains responsible. Even when supervising remotely, the physician is ultimately liable for care delivered in their practice and must ensure appropriate oversight, staff training, and patient safety protocols.
- Adequate technology is required. The ability of the physician to supervise remotely depends upon the reliability of the technology used.
Practices should evaluate whether remote supervision is appropriate for each service and patient scenario.
The rule applies to Medicare only
It is important to note that this rule applies to Medicare only. Commercial payers may have different supervision requirements, and practices should verify policies with each payer before implementing remote supervision for privately insured patients.
For information about other Medicare and federal rules and regulations, check out the College’s Risk and Compliance Toolkit. For billing and coding information, review the College’s Coding Toolkit.
