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October 7, 2025, marks a milestone for California radiology.
Governor Gavin Newsom has officially signed Assembly Bill 460 (AB 460) into law, modernizing the state’s definition of “direct supervision” for contrast-enhanced imaging procedures.
Beginning January 1, 2026, radiologists in California will be able to meet supervision requirements either in person or remotely via real-time audio and video, with full access to imaging records and the ability to direct licensed onsite personnel.
This marks the first time California has formally recognized virtual supervision as an equivalent, compliant form of direct oversight for contrast-enhanced CT and similar procedures — aligning state policy with existing Centers for Medicare & Medicaid Services (CMS) rules that have been in place since 2020.
What AB 460 Changes
For decades, California required supervising physicians to be physically present within the facility whenever contrast was administered by a technologist — a rule that limited flexibility and often constrained access to care, particularly in rural or multi-site imaging settings.
AB 460 updates this outdated framework by allowing:
- Virtual direct supervision: Radiologists may now provide real-time oversight via secure audio/video communication (excluding audio-only).
- Immediate availability: The supervising physician must remain available to intervene or direct onsite personnel if needed.
- Access to imaging records: Physicians must have immediate access to the relevant imaging information to inform their supervision.
Key compliance detail: When supervision is provided remotely, facilities must have:
- Written safety protocols for contrast administration and emergencies, and
- Onsite licensed personnel — a physician, registered nurse (RN), nurse practitioner (NP), clinical nurse specialist (CNS), or physician assistant (PA) — available to respond at the physician’s direction.
This onsite requirement must be reflected in both protocol documentation and staffing models for compliance.
Why AB 460 Matters for Imaging Centers
AB 460 represents a transformative update for outpatient imaging and radiology operations.
1. Expands Access to Care
For rural and community-based imaging centers, the ability to leverage virtual supervision ensures patients can access contrast-enhanced exams without delays or rescheduling due to radiologist availability.
2. Strengthens Patient Safety
By requiring trained onsite clinicians and standardized emergency protocols, the new law maintains — and in many cases, enhances — safety standards while enabling modern, technology-driven workflows.
3. Aligns with CMS Policy
CMS has recognized virtual direct supervision for diagnostic testing and incident-to services since 2020. AB 460 finally brings California’s Health & Safety Code into alignment with these federal standards, eliminating the compliance tension between state and federal definitions.
4. Reduces Operational Bottlenecks
Facilities can now scale coverage across multiple sites more efficiently, improving scheduling flexibility and optimizing radiologist workloads — without sacrificing oversight or compliance.
Tether Supervision’s Role in the Legislative Process
Tether Supervision closely tracked and contributed to AB 460 from its early drafts through final passage.
Our policy and operations team submitted written feedback and recommendations that helped refine the bill’s language — including clarifying the scope of virtual supervision and the requirements for onsite clinical responders.
We also worked alongside imaging leaders and advocacy groups to ensure the legislation supports:
- Equitable access for small, rural, and independent imaging centers
- Clarity for radiologists and administrators designing compliant workflows
- Consistency with federal CMS and ACR standards
AB 460’s final language reflects a balance between safety, access, and operational practicality — the same balance that underpins Tether’s supervision model.
Preparing for Implementation: What Centers Should Do Now
With the law set to take effect on January 1, 2026, imaging centers should begin preparing their infrastructure, documentation, and staff training now.
Tether recommends:
- Reviewing current supervision protocols to identify areas that require revision for compliance under AB 460.
- Updating written procedures to incorporate virtual oversight workflows, including contrast reaction escalation and documentation standards.
- Verifying onsite coverage — ensure licensed personnel are consistently available to respond during remote supervision.
- Implementing HIPAA-compliant AV technology capable of supporting real-time communication and record access.
- Training technologists and onsite staff on the new expectations for communication and escalation under virtual oversight.
Tether provides direct guidance and implementation support to imaging centers navigating this process, ensuring a smooth transition that’s fully compliant by 2026.
A Win for Radiology — and for Patients
AB 460 is more than a policy win. It’s a signal that California is ready to modernize supervision and embrace the proven safety and efficiency of virtual radiology oversight.
- For imaging centers, it means fewer delays, more flexibility, and broader patient access.
- For radiologists, it means a sustainable, scalable model for coverage.
- For patients, it means timely, high-quality care delivered where and when it’s needed most.
At Tether Supervision, we’re proud to have supported this effort and remain committed to helping imaging centers translate legislation into safe, compliant, real-world practice.
We’re here to help your center prepare for implementation in 2026 — and lead confidently through the transition.
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