A split or shared visit is an E/M visit performed in part by both a physician and a nonphysician practitioner (NPP) who are in the same group, in accordance with applicable law and regulations such that the service could be billed by either the physician or NPP if furnished independently by only one of them. One of the practitioners must have a face-to-face visit with the patient. Payment is made to the practitioner who performs the substantive portion of the visit. The substantive portion can be entirely with or without direct patient contact and is determined by the proportion of total time, not whether the time involves patient contact.
The substantive portion of a visit is comprised of any of the following elements:
- History
- Physical Exam
- Medical Decision Making
- Time
- When the practitioners jointly meet with or discuss the patient, only the time of one of the practitioners can be counted.
The following is a list of activities that can be counted toward total time for purposes of determining the substantive portion:
- Preparing to see the patient
- Obtaining and/or reviewing separately obtained history
- Performing a medically appropriate examination and/or evaluation
- Counseling and educating the patient/family/caregiver
- Ordering medications, tests, or procedures
- Referring and communicating with other health care professionals (when not separately reported)
- Documenting clinical information in the electronic or other health record
- Independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver
- Care coordination (not separately reported)
Practitioners cannot count time spent on the following:
- The performance of other services that are reported separately
- Travel
- Teaching that is general and not limited to discussion that is required for the management of a specific patient
For critical care visits, the substantive portion is more than half of the total time. Beginning January 1, 2024, for all E/M services the substantive portion will be more than half of the total time spent by the physician and NPP performing the split or shared visit.
Sources:
CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 12, section 30.6.18
Split/Shared E/M Visits
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