Split/Shared Visits in Medical Coding: Billing Guidelines & Tips
Understanding how to accurately code and bill for split/shared visits is essential for compliance and proper reimbursement, especially with evolving CMS guidelines. If you work in a setting where both physicians and non-physician practitioners (NPPs) deliver care to a patient during the same encounter, this article will guide you through the correct way to code and bill these services.
What Is a Split/Shared Visit?
A split/shared visit refers to a medically necessary evaluation and management (E/M) service performed jointly by a physician and a non-physician practitioner (NPP) (e.g., nurse practitioner or physician assistant) on the same calendar day in a facility setting (such as a hospital or skilled nursing facility).
Important: Split/shared services do not apply in office or outpatient settings for Medicare billing purposes.
2025 CMS Guidelines Overview
CMS updated its definition and requirements in recent years. Here are the current highlights:
Same Calendar Day: Both providers must see the patient on the same day.
Facility Setting Only: Applies in inpatient, outpatient hospital, observation, emergency department, or SNF (not office settings).
Substantive Portion: The practitioner who performs the “substantive portion” of the visit should bill the service.
In 2024, time is the primary measure of the substantive portion.
>50% of total time must be spent by the billing provider.
Documenting a Split/Shared Visit
Proper documentation is critical for compliance. It should include:
Both providers’ names and credentials
Clear indication that the visit was split/shared
Total time spent with the patient and who spent what time
The provider who performed the substantive portion must sign and date the documentation
Tip: Avoid cloning or copying notes from each other’s documentation—CMS expects individualized entries from both practitioners.
Medical Coding MDM https://codingclarified.com/medical-coding-mdm/
Evaluation and Management (E/M) Coding https://codingclarified.com/e-m-2025/
Billing and Modifier Guidance
Use the provider’s NPI who performed the substantive portion
No modifier (like -FS) is required by CMS yet, but some payers or EMR systems may ask for internal tracking
Check with commercial payers: not all follow CMS rules
Best Practices & Tips
Track Time Diligently: Use EMRs or paper documentation to log exact time spent.
Train Teams Together: Physicians and NPPs must be on the same page with documentation expectations.
Review Payer Policies: Private insurers may differ from CMS on settings or billing rules.
Audit Regularly: Internal reviews can help identify compliance issues before they become costly errors.
Why It Matters
Incorrectly billing a split/shared visit can lead to:
Overpayment recoupments
Audits or penalties
Compliance issues under Medicare rules
Getting it right ensures fair payment while protecting your practice from regulatory trouble.
Split/shared visits allow collaborative care in facilities, but they come with strict billing rules. Ensure you’re coding based on time in 2024, document clearly, and always follow payer-specific guidelines
CMS Medicare’s Split/Shared Visit Policy https://www.cms.gov/files/document/mm13592-updates-split-or-shared-evaluation-management-visits.pdf