Procedures which are generally and traditionally accepted as those which may be carried out by a
nurse, nurse practitioner or a medical assistant in the employ of a medical practitioner may, when so
performed, only be billed to MSP by the medical practitioner when the performance of the procedure is
under the “direct supervision” of the medical practitioner or a designated alternate medical practitioner
with equivalent qualifications. Direct supervision requires that during the procedure, the medical
practitioner be physically present in the office or clinic at which the service is rendered. While this does
not preclude the medical practitioner from being otherwise occupied, s/he must be in personal
attendance to ensure that procedures are being performed competently and s/he must at all times be
available immediately to improve, modify or otherwise intervene in a procedure as required in the best
interest of the patient. Billing for these procedures also implies that the medical practitioner is taking full responsibility for their medical necessity and for their quality. Any exceptions to this rule are subject
to the written approval of MSP.
“Procedures” in this context do not include such “visit” type services as examinations/ assessments,
consultations, psycho-therapy, counselling, telehealth services, etc., which may not be delegated.
The foregoing limitations do not apply to approved procedures rendered in approved “diagnostic
facilities”, as defined under the Medicare Protection Act and Regulations and which are subject to
accreditation under the Diagnostic Accreditation Program.
Diagnostic Facility Services
Diagnostic Facility Services are defined under the Medicare Protection Act as follows:
“Medically required services performed in accordance with protocols agreed to by the Commission, or
on order of the referring practitioner, who is a member of a prescribed category of practitioner, in an
approved diagnostic facility by, or under the supervision of, a medical practitioner who has been
enrolled, unless the services are determined by the Commission not to be benefits.”
