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:
The following is a list of activities that can be counted toward total time for purposes of determining the substantive portion:
Practitioners cannot count time spent on the following:
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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