What is the highest level that can be billed by a resident without the presence of a teaching physician?

The highest level that can be billed by a resident without the presence of a teaching physician is Level III. This level indicates that the resident has evaluated the patient independently and that the complexity of the visit requires a moderately detailed history and examination.

In the setting of residency, billing guidelines established by Medicare and other third-party payers allow residents to bill for services rendered independently, up to certain levels based on their training and the complexity of the patient’s condition. Level III typically involves cases that are more intricate, but they do not require direct supervision by the attending physician.

Levels I and II represent less complex evaluations and may not require as much clinical judgment as is displayed in Level III assessments. Level IV would indicate a higher complexity that, under normal circumstances, necessitates the teaching physician's presence for billing purposes, as these encounters often involve decision making at a higher level. Thus, Level III stands as the threshold where independent billing is permissible for residents without the supervising physician's presence.