Can an evaluation and management (E/M) service be performed as a split or shared service?

A split or shared E/M visit is defined by Medicare Part B payment policy as a medically necessary encounter with a patient where the physician and a qualified NPP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service. A substantive portion of an E/M visit involves all or a portion the key components of the service provided: history, physical exam, or medical decision making. The physician and the qualified NPP must be in the same group practice or be employed by the same employer.

The split or shared E/M visit applies only to selected E/M visits and settings (i.e., hospital inpatient, hospital outpatient, hospital observation, emergency department, hospital discharge, office and non facility clinic visits, and prolonged visits associated with these E/M visit codes). The split or shared E/M policy does not apply to critical care services or procedures.

A split/shared E/M visit cannot be reported in the SNF/NF setting.

Resource: CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 12, Section 100.1.4 and 30.6.13 (PDF, 1.5 MB)

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