42 CFR 410.1542 CFR 410.26Virtual supervision, permanent in 2026
Medicare pays for a yearly check-in with every patient who has Part B, called the annual wellness visit. It is not a physical, there is no examination, and the patient owes nothing for it. It is a conversation: health history, medications, risk factors like falls or low mood, and a written plan for the screenings and preventive care that should happen over the next several years.
Medicare pays the practice for that conversation using one code for a patient's first ever visit and a second code for every year after it. The money is not in dispute and never has been. What practices ask us about is the arrangement: a nurse we do not employ, on a telephone, while our physician is somewhere else. That is the part this page is for.
The short version is that it rests on three rules that were already on the books, and it is written out below in the order they apply.
Read left to right. The first rule says a nurse may do the visit. The second says that nurse need not be on your payroll. The third says the supervising physician need not be in the room. Nothing here is a workaround, and nothing here is novel.
Medicare's own definition of the health professional who furnishes an annual wellness visit includes a medical professional, or a team of them, working under the direct supervision of a physician. The doctor does not have to be the person having the conversation. Most of the visit is history, structured screening, and a written prevention schedule, which is nursing work.
Auxiliary personnel means any individual acting under the physician's supervision, regardless of whether that individual is an employee, a leased employee, or an independent contractor of the physician or of the entity that contracts with them. A practice may contract the nurse in.
Direct supervision means present in the office suite and immediately available throughout. Since 1 January 2026 that presence may be a virtual one, through real-time audio and video excluding audio-only. It was adopted permanently in the CY2026 Physician Fee Schedule final rule, not extended as a flexibility with an expiry date.
This is the question a compliance officer asks first, so it gets answered before anything else on this page.
We never bill Medicare. No claim is submitted by us, on your behalf or otherwise, and TULQ does not appear on the claim you submit.
We are not paid by Medicare. No part of our fee comes out of a federal programme directly, and we do not take a percentage of what you collect.
We do not hold your credentials. No TULQ login exists in your medical record system unless you choose to create one.
You bill Medicare under your own supervising physician, exactly as you would if the visit had been performed by someone on your own staff. Only the supervising practitioner may bill an incident-to service, and that is you.
You pay TULQ a flat fee for each completed visit, as an ordinary commercial expense, in the same shape as a staffing agency or a billing service.
You keep the record and the relationship. The signed note lives in your system, filed by your people.
This is the part people usually picture wrong. The finished note reaches the chart as a signed document, filed by your own staff, so there is no gap in who controls the record and no outside access to your software.
A short medication list and health history goes to the nurse before the call. Nobody at TULQ needs a login to produce it.
A licensed registered nurse conducts the wellness visit by telephone, covering every element the benefit requires, while the supervising physician is reachable on live video.
The visit is documented in TULQ's own system and rendered as a finished document, complete and ready for a signature rather than a transcript for someone else to convert.
It travels to the practice through an agreed private channel under a signed business associate agreement. It does not travel through anyone's inbox.
The supervising physician reviews and signs, and your own people file it in your own medical record system. The chart is never touched by an outside hand.
A licensed nurse performing every required element under a physician's real-time supervision, with a signed record proving it, is what the benefit asks for. Shared rows are ones neither side owns alone.
The elements the regulation requires before the visit is billable. Our nurses cover every one on every call.
A visit that happened but cannot be evidenced is the one that becomes a repayment two years later.
A federal rule lets a nurse do this visit instead of the physician. A second federal rule lets that nurse be supplied by an outside company rather than being an employee of the practice. A third lets the physician supervise by live video instead of standing in the room.
The practice bills Medicare as usual and pays TULQ separately for the nurse's time. The signed record ends up filed in the practice's own system by the practice's own staff. Every piece of that chain is built on an existing federal rule, not a workaround.
None of which is the same as saying it runs itself. The supervision obligation is real, the documentation standard is real, and both sit with your practice. What we are telling you is where they sit, not that they went away.
Yes. The regulation defining who may furnish the visit lists a physician, a qualified non-physician practitioner such as a physician assistant, nurse practitioner or clinical nurse specialist, and also a medical professional or a team of medical professionals working under the direct supervision of a physician. A registered nurse works under that third route.
What the nurse cannot do is make the supervision requirement or the billing obligation disappear. Both stay with your practice.
Source: 42 CFR 410.15No. The incident-to regulation defines auxiliary personnel as any individual acting under the supervision of the physician, regardless of whether that person is an employee, a leased employee, or an independent contractor of the physician or of the entity that contracts with them. That is the provision a staffing arrangement rests on, and it is the same one behind a locum nurse or a contracted phlebotomist.
Source: 42 CFR 410.26Not since 1 January 2026. Direct supervision still means the physician is immediately available to furnish assistance and direction throughout, but the presence required may now be a virtual one, through real-time audio and video interactive telecommunications. Audio-only does not satisfy it, and the allowance does not extend to services carrying a 010 or 090 global surgery indicator, which the wellness visit does not.
CMS adopted this permanently in the CY2026 Physician Fee Schedule final rule rather than extending it as a dated flexibility, which is what makes a standing telephone visit programme practical to run.
Source: 42 CFR 410.32(b)(3)(ii)Your practice does, under your own supervising physician, exactly as if one of your own staff had performed the visit. TULQ never bills Medicare, never submits a claim, and never appears on one. Only the supervising physician or practitioner may bill for incident-to services, which the regulation states in as many words.
Source: 42 CFR 410.26(b)(5)By the practice, as a flat fee for each completed visit. That is a private commercial transaction, separate from the Medicare claim, and it is the same shape as the arrangement a practice already has with a staffing agency or a billing service.
We do not take a percentage of what you collect. A revenue share is not unlawful and several vendors run one, but it is a different compliance posture, and a flat fee per completed visit is the one we would rather explain to your compliance officer.
No, and by default they do not have it. Your front desk sends a short chart summary out, the nurse works from that, and a finished document comes back through a secure channel for your own staff to sign and file. No TULQ credential exists in your system unless you decide to create one.
Some practices prefer to grant delegated access so the note lands directly where the biller looks. That works too, under a signed business associate agreement. The point is that it is your choice rather than a condition of the service.
For established patients, yes. The annual wellness visit sits on the Medicare telehealth list and audio-only delivery is permitted under the telehealth flexibilities, which the Consolidated Appropriations Act of 2026 extended through 31 December 2027. New patients generally still need to be seen in person.
Note that these two rules are separate and it is worth keeping them apart. The supervising physician's virtual presence is permanent. The patient-facing audio-only allowance is dated, so check the current CMS telehealth list rather than assuming the position holds.
Source: CMS Medicare telehealthThe note has to show more than that a conversation happened. It has to evidence each required element, name who performed the visit and their credential, and record that the supervising physician was available throughout. Ours does all three on every visit, because a wellness visit programme that cannot prove the supervision is the one that becomes a repayment.
Source: CMS Medicare Wellness Visits, MLN6775421Every claim on this page is linked to the primary document rather than to a summary of it. Nothing below is behind a paywall.
This page summarises federal requirements as they stood in August 2026 for a general audience. It is not legal, billing, or compliance advice and it does not substitute for review by qualified counsel or your own compliance officer. Coverage and supervision rules change, and the patient-facing audio-only telehealth allowance in particular carries a date, so confirm the current position with CMS and your MAC before relying on any of it.
That is genuinely the fastest way to find out whether this works for you. If the answer comes back with questions, put us on the call. We would rather have the hard conversation before a contract than after a claim.
Ask and we will send it the same day, with the regulatory citations written out in full so your counsel can check them rather than take our word for it.
