Shared/Split Evaluation and Management Visits
A shared/split Evaluation and Management (E/M) visit is defined as a medically necessary encounter with a patient in the facility setting performed in part by both a physician and a Non-Physician Practitioner (NPP) each with the same patient on the same date of service. The physician and the qualified NPP must be in the same group practice.
A “substantive portion” of an E/M visit involves all or some portion of the history, exam, or medical decision making (MDM) key components of an E/M service, or more than half of the total time spent by the physician and NPP performing the shared/split visit. Except for critical care visits, the substantive portion can be one of these three key components, or more than half of the total time spent by the physician and NPP performing the shared/split visit.
The practitioner who spends more than half the total time, or performs the history, exam, or MDM has performed the substantive portion and can bill for the shared/split visit. When one of the three key components is used as the substantive portion, the practitioner who bills the visit must perform that component in its entirety in order to bill.
“Beginning January 1, 2023, substantive portion means more than half of the total time spent by the physician and NPP performing the shared/split visit.” Pub 100-04 Medicare Claims Processing manual. 30.6.18.B(1)
The practitioner who furnished the substantive portion of the visit bills for the visit.
Note: [NPP includes the terms “Nurse Practitioner (NP)”, “Physician Assistant (PA)” and Certified Nurse Midwife (CNM)].
According to the Centers for Medicare & Medicaid Services (CMS), shared/split visits are applicable for services rendered in the following settings:
- Hospital inpatient or outpatient
- Emergency department
- Hospital observation
- Hospital discharge
- In a skilled nursing facility
- For critical care services (99291-99292)
Hospital or SNF E/M visits may be billed as shared/split visits if they meet the rules for shared/split visit billing, except for E/M visits that are required to be performed in their entirety by a physician. Nursing facility visits do not meet the definition of shared/split services, and therefore, are not billable as such.
Shared/split visits are not allowed:
- In an office or clinic
- For consultation services
- For procedures
- In a nursing facility setting
- In a patient’s home or domiciliary site
Shared/split visits are not considered “incident to” services.
NC Medicaid Contact Center, 888-245-0179