Virtual direct supervision still an option if telehealth waivers end
by Julia Kyles, CPC on Jan 29, 2026
Remind staff that the virtual direct supervision rule will remain even if Congress fails to extend telehealth waivers by Jan. 30.
Some background: CMS introduced a virtual direct supervision waiver during the COVID-19 public health emergency. The waiver allowed remote supervision of ancillary staff who were performing in-person services.
In 2023, CMS clarified that the waiver was also designed to facilitate “the provision of telehealth services by clinical staff ‘incident to’ the professional services of physicians and other practitioners.”
In other words, the direct supervision waiver is not a telehealth waiver, even though it can be used for telehealth services.
Direct supervision means, except as provided in
paragraphs (a)(2)(i) and
(ii) of this section, the level of supervision by the physician (or other practitioner) of auxiliary personnel as defined in
§ 410.32(b)(3)(ii). The presence of the physician (or other practitioner) required for direct supervision may include virtual presence through audio/video real-time communications technology (excluding audio-only) for services without a 010 or 090 global surgery indicator.