Split or Shared Services - JE Part B
Split or Shared Services
Split or shared visits means an evaluation and management visit in the facility setting that is performed in part by both a physician and a nonphysician practitioner 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 nonphysician practitioner if furnished independently by only one of them.
- Work provided may be both face-to-face and non-face-to-face
- Payment is made to the practitioner who performs the substantive portion of the medical decision making (MDM) or total time for the visit
Definition of Substantive Portion
For CY 2024, the CMS definition of substantive portion of a split or shared visit includes the revisions to the CPT guidelines. The "substantive portion" means:
- More than half of the 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 medical decision making
Medicare will allow time or medical decision making to serve as the substantive portion of a split or shared visit.
During the transitional years, 2022 and 2023, except for critical care visits, the substantive portion can be one of the three key E/M visit components (history, exam, or medical decision-making [MDM]), or more than half of the total time spent by the physician and NPP performing the split or shared visit.
When one of the three key components is used as the substantive portion in 2022 and 2023, the practitioner who bills the visit must perform that component in its entirety to bill.
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 number. The medical record must identify both providers involved in the split or shared E/M service and be signed by the billing provider.
Documentation would include:
- Identity of both providers who perform the visit
- Who performed the substantive portion of the visit
Append modifier FS (Spit or Shared E/M Visit) to the E/M code to report these services.
