CMS physician visit requirements for nursing homes set a firm schedule: a resident must be seen by a physician within 30 days of admission, then at least once every 30 days for the first 90 days, and at least once every 60 days after that for the rest of the stay. The rules sit at 42 CFR Part 483 and apply to every Medicare- or Medicaid-certified Skilled Nursing Facility (SNF) and Nursing Facility (NF).1eCFR. 42 CFR Part 483 Subpart B – Requirements for Long Term Care Facilities Miss them, and the facility exposes itself to daily fines, blocked admissions, and in serious cases loss of its provider agreement.
Admission Orders and the First Visit
Two things have to happen when a resident walks through the door. The facility needs physician orders covering immediate care on the day of admission, and a physician has to personally approve the admission in writing. Admission orders themselves can be written by a physician, nurse practitioner, physician assistant, or clinical nurse specialist, so treatment does not stall while the resident waits for a full physician evaluation.1eCFR. 42 CFR Part 483 Subpart B – Requirements for Long Term Care Facilities
The comprehensive initial visit is a separate obligation. It must occur no later than 30 days after admission and must cover the resident’s medical condition, all medications and treatments, and the plan of care going forward. In an SNF, the physician performs this initial visit personally; delegation to a nurse practitioner, physician assistant, or clinical nurse specialist is not allowed. In an NF, a qualifying non-physician practitioner who is not employed by the facility and who collaborates with a physician may conduct the initial visit if state law permits.2eCFR. 42 CFR 483.30 – Physician Services
The Ongoing 30- and 60-Day Schedule
After the initial visit, the required frequency is straightforward:
- At least once every 30 days for the first 90 days after admission.
- At least once every 60 days after that, for as long as the resident remains in the facility.
Each visit has to include a review of the resident’s total program of care, with medication and treatment adjustments ordered as needed.2eCFR. 42 CFR 483.30 – Physician Services
The 10-Day Slippage Rule
Real schedules slip. Regulators know this, so a visit still counts as timely if it happens within 10 days after the date it was originally due. A visit due March 1 is still timely if it occurs by March 11.2eCFR. 42 CFR 483.30 – Physician Services The slippage does not reset the clock. The next visit is measured from the original due date, not from the day the late visit actually happened.
Visits Between the Required Ones
The 30- and 60-day marks are floors. CMS guidance is explicit that the slippage allowance and delegation rules do not excuse a physician from coming in whenever a resident’s condition calls for it. A new acute illness, a significant change in status, or a medication issue that needs hands-on evaluation requires a personal visit regardless of where the calendar sits.
Who Can Perform the Required Visits
The delegation rules split along the SNF/NF line, and this is where facilities and families get tripped up.
Skilled Nursing Facilities
In an SNF, after the physician-only initial visit, subsequent required visits may alternate between the physician and a non-physician practitioner. The physician has to handle at least every other visit. The NPP must meet the applicable federal definition, work within their state scope of practice, and operate under the supervising physician’s oversight.2eCFR. 42 CFR 483.30 – Physician Services A physician cannot delegate anything the regulations reserve as personal, and cannot delegate what state law or the facility’s own policies bar from being delegated.
Nursing Facilities
NFs get more room. At the state’s option, any required physician task, including tasks the regulations otherwise treat as personal, may be performed by a non-physician practitioner who is not employed by the facility and is collaborating with a physician. In a state that has taken this option, a qualifying NPP can conduct every required visit, including the initial one.2eCFR. 42 CFR 483.30 – Physician Services
Coverage When the Attending Is Away
Whatever the delegation setup, another physician must supervise a resident’s medical care when the attending is unavailable. The facility cannot leave residents uncovered between scheduled visits.2eCFR. 42 CFR 483.30 – Physician Services
Telehealth Does Not Replace the In-Person Visit
This is the most misread part of the rules. In the 2026 Physician Fee Schedule final rule, CMS permanently removed telehealth frequency limits on subsequent nursing facility visits, effective January 1, 2026.3Centers for Medicare & Medicaid Services. Telehealth FAQ – CMS That is a billing change. Medicare will reimburse telehealth nursing facility visits without capping how many can occur. It does not change 42 CFR ยง 483.30(c)(3), which still requires that mandatory physician visits be made personally.
During the COVID-19 public health emergency, CMS temporarily allowed the required visits to be done via telehealth. Those waivers have expired. The scheduled 30- and 60-day visits must now be conducted in person. Telehealth can fill in additional check-ins between the required visits and can be billed, but it does not substitute for the in-person visit on the schedule.3Centers for Medicare & Medicaid Services. Telehealth FAQ – CMS
Documenting the Visit
Every required visit has to produce a progress note in the medical record covering the resident’s current condition, examination findings, clinical reasoning, and any changes to the care plan. The practitioner signs and dates the note. A missing signature can be cured after the fact through an attestation statement, but orders cannot be authenticated that way once the fact.4Centers for Medicare & Medicaid Services. Complying with Medicare Signature Requirements
All orders for medications, treatments, and dietary or therapy changes must be signed and dated by the physician or authorized NPP. When the entries immediately above and below an undated note are both dated, reviewers may infer the date of the undated entry, but the safer practice is to date everything at the time it is written. Unsigned or undated records are among the most common reasons Medicare denies claims on review.4Centers for Medicare & Medicaid Services. Complying with Medicare Signature Requirements
The Resident Chooses the Physician
Families sometimes assume the facility assigns a doctor. It doesn’t. Federal law gives every nursing home resident the right to select their own attending physician, provided the physician is licensed. If the chosen physician refuses to comply with the facility’s regulatory requirements or cannot meet them, the facility may look for an alternative, but it must discuss the options with the resident and honor the resident’s preference among what is available. A later change of physician has to be honored too, as long as the new physician meets the requirements.5eCFR. 42 CFR 483.10 – Resident Rights
What Happens When a Facility Falls Behind
When CMS finds a facility out of compliance with the visit rules, it can reach for any of several remedies:6Centers for Medicare & Medicaid Services. Nursing Home Enforcement – Frequently Asked Questions
- Civil money penalties, imposed per day or per instance. For deficiencies that pose immediate jeopardy to residents, per-day penalties run from $8,351 to $27,378. Non-immediate-jeopardy deficiencies that cause or risk harm carry per-day penalties from $136 to $8,211. Per-instance fines range from $2,739 to $27,378.7Federal Register. Annual Civil Monetary Penalties Inflation Adjustment
- Denial of payment for new admissions until deficiencies are corrected.
- State monitoring, often with unannounced follow-up inspections.
- A directed plan of correction, where CMS dictates the fix rather than letting the facility propose one.
- Directed in-service training on the deficient area.
- Temporary management installed by CMS until compliance is restored.
- Termination of the provider agreement. In immediate-jeopardy cases, CMS must terminate within 23 calendar days if the jeopardy is not removed.
The dollar figures are adjusted annually for inflation; the amounts above come from the January 2026 Federal Register adjustment. A facility with immediate-jeopardy findings tied to physician visit failures can accumulate six-figure fines within a matter of days.