Does the physician have to be in the room for the hospital to bill a barium swallow (74230)?


Yes, the technical code requires personal physician supervision. The Medicare Benefit Policy Manual, chapter 6, section 20.4.4 details the rules for outpatient hospital requirements for diagnostic tests. It says:

“As specified at 42 CFR 410.28(e), payment is allowed under the hospital outpatient prospective payment system for diagnostic services only when those services are furnished under the appropriate level of supervision specified in accordance with the definitions in this manual and at 42 CFR 410.32(b)(3)(i), (b)(3)(ii), and (b)(3)(iii) of general, direct and personal supervision.”

The manual notes that the supervision levels listed in the quarterly updated Medicare Physician Fee Schedule (PFS) Relative Value File apply to outpatient hospital billing. You can find the instructions at

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