March 22, 2021
Split/Shared Services
The purpose of this article is to provide guidance on the appropriate documentation of split/shared services. A Split/Shared service is when both physician or nonphysician practitioner (NPP) in the same group perform in a facility setting, and in accordance with applicable law and regulations (either the physician or NPP can bill the service if they provide it independently) provide a portion of the evaluation and management (E/M) service.
- CMS considers the practitioner who spends more than half of the total time or performs the substantive part of medical decision making (MDM) to have performed the substantive portion and can bill for the split or shared E/M visit.
- This encounter must consist of more than a review of the medical record by the physician.
Definition of Substantive Portion:
For CY 2024, CMS defines substantive portion of a split or shared visit as:
- More than half of total time spent by the physician or nonphysician practitioner performing the split or shared visit, OR
- More than half of the substantive part of the MDM
Medicare will allow time or medical decision making to serve as the substantive portion of a split or shared visit.
For critical care visits, starting for services furnished in CY 2022, the substantive portion will be more than half of the total time.
Billing Provider
The provider performing the substantive portion will submit the appropriate level of E/M service under their name and NPI. The medical record must identify both providers involved in the split or shared E/M service and be signed by the billing provider.
Resources
Revised July 10, 2024
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