The Centers for Medicare & Medicaid Services (CMS) recently issued the Outpatient Prospective Payment System final rule for 2011 with significant changes to the direct supervision requirements for hospital therapeutic and diagnostic services. Under the final rule, providers meets the direct supervision requirements if a physician is physically present, interruptible, and available to provide assistance and direction for therapeutic and diagnostic services. Previously, providers met the requirements only if the physician was physically present and immediately available to provide assistance and direction. The 2011 final rule does not include any reference to physical boundaries in the revised direct supervision provisions. The final rule also allows direct supervision, followed by general supervision, for a limited set of nonsurgical extended duration therapeutic services. Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 410, 411, 412, et al. Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Payments to Hospitals for Graduate Medical Education Costs; Physician Self‐Referral Rules and Related Changes to Provider Agreement Regulations; Payment for Certified Registered Nurse Anesthetist Services Furnished in Rural Hospitals and Critical Access Hospitals; Final Rule, 75 Fed. Reg. 217, 71799, 72580 (Nov. 24, 2010).