Split or Shared Services

Split or shared visits refer to evaluation and management visits performed in part by a physician and in part by other nonphysician practitioners in an institutional facility setting. Physicians and nonphysician practitioners (NPP) performing the visits are in the same group practice, 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.

  • 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 visit

Settings of Care

An institutional facility setting means a setting in which payment for services and supplies furnished incident to a physician or practitioner’s professional services is prohibited under Medicare regulations.
42 CFR 415.140 - Conditions for payment: Split (or shared) visits

Noninstitutional setting means all settings other than a hospital or skilled nursing facility.
42 CFR 410.26 - Incident to physician's professional services

Split or shared services would only be provided in a setting where incident to rules would not be allowed. If the patient receives a visit in an office visit setting where they would come in for the visit and leave within a few hours, incident to rules would apply. If the patient is staying in a hospital or SNF bed as an inpatient or in observation, split or shared may apply, and incident to would not be available.

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.

Last Updated Jun 10 , 2024