Crystal's MCW Coder HubTags: rules inpatient medicare
Definition
A split/shared visit is an E/M service provided jointly by a physician and a non-physician practitioner (NPP) in the same group.
2024 Medicare Changes
Substantive Portion
Starting 2024, the substantive portion determines who bills:
- More than half of total time, OR
- Most of the MDM
Requirements
| Element | Requirement |
|---|---|
| Same Group | Must be same specialty/group |
| Same Day | Services on same calendar date |
| Face-to-Face | Both must have face-to-face contact |
| Documentation | Both must document their portion |
Billing Rules
Physician Bills When
- Physician performs substantive portion
- Modifier -FS required
NPP Bills When
- NPP performs substantive portion
- No modifier required
Documentation
Split/Shared Visit Documentation:
- Provider A: 20 minutes, reviewed labs
- Provider B: 25 minutes, patient exam
- Total time: 45 minutes
- Substantive portion: Provider B
- Billing provider: Provider B
Teaching Settings
Split/shared rules do NOT apply in teaching physician settings. Different rules apply.
Not Allowed For
- Critical care services (99291-99292)
- Consultation codes
- Procedures (only E/M)
- Different specialties (generally)
Time Tracking
Each provider should document their individual time and activities for compliance.
00 Inpatient ProFee Coding MOC Teaching Physician Rules Inpatient Modifiers