A split/shared visit is a facility-setting E/M service, such as in a hospital, emergency department or SNF, performed jointly by a physician and a nonphysician practitioner in the same group. Medicare pays it under the practitioner who performs the substantive portion, meaning more than half of the total time or the substantive part of the medical decision making, and the claim must carry modifier FS.
Medical Coding Split/Shared Visits: Billing Guidelines & Tips
Understanding accurate billing and medical coding 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 billing does not apply in the physician office (non-facility) setting for Medicare. In the office, incident-to rules apply instead.
2026 CMS Guidelines Overview
CMS updated its definition and requirements in recent years. Here are the current highlights:
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Same Calendar Day: Both providers must see the patient on the same day.
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Facility Setting Only: Applies in inpatient, outpatient hospital, observation, emergency department, or SNF (not office settings).
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Substantive Portion: The practitioner who performs the “substantive portion” of the visit should bill the service.
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Since January 1, 2024, the substantive portion is either more than half of the total time or the substantive part of medical decision making (MDM).
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When time is used, the billing practitioner must spend more than half of the combined total time. When MDM is used, the billing practitioner must perform the substantive part of the MDM.
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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 Medical Coding MDM
Evaluation and Management (E/M) Coding E M 2025
Billing and Modifier Guidance
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Use the provider’s NPI who performed the substantive portion
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Append modifier FS (split or shared E/M visit) to the claim line. CMS has required it since January 1, 2022
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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:
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Overpayment recoupments
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Audits or penalties
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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 CMS split or shared E/M visit updates
Frequently Asked Questions About Split/Shared Visits
What is the substantive portion of a split/shared visit?
For Medicare, it is either more than half of the total time spent by both practitioners or the substantive part of the medical decision making. The practitioner who performs it bills the visit.
Is modifier FS required for split/shared visits?
Yes. Medicare requires modifier FS on split/shared E/M visits, and has since January 1, 2022. Commercial payers may have their own rules.
Do split/shared rules apply in the physician office?
No. Split/shared billing applies only in facility settings. In the office, services by a nonphysician practitioner are billed under the NPP or, when all requirements are met, under incident-to rules.
Can critical care be billed as split/shared?
Yes. Medicare allows critical care to be billed as split/shared, using total time to decide the substantive portion and reporting modifier FS.
What should documentation show for a split/shared visit?
Both practitioners’ names and signatures, what each one did, and the time each spent when time decides the substantive portion. See our E/M coding guidelines for MDM and time rules.