MLN: Split (or Shared) E/M Visits
Reference to the Medicare rules for E/M services furnished jointly by a physician and an NPP in a facility setting, with the substantive-portion rule determining who reports.
Primary source
CMS Physician Fee Schedule Split (or Shared) Visits Policy →https://www.cms.gov/medicare/payment/fee-schedules/physician/split-shared-visits
Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.
Additional sources
Split (or shared) visits are E/M services furnished jointly by a physician and a non-physician practitioner (NP, PA, CNS) of the same group in a facility setting — typically a hospital inpatient or outpatient department. The CMS split (or shared) visits policy defines who reports the visit and the documentation required.
Through 2024 transitional policy, the visit is reported by whichever practitioner performed the substantive portion. The substantive portion may be either: more than half of the total time, or substantive part of the MDM. The CY2024 PFS finalized that for CY2024 and ongoing, the substantive portion is defined either way at the practitioner's election.
Documentation requirements:
- The medical record must identify the two practitioners and what each performed.
- The practitioner reporting must sign and date the note.
- Both practitioners must furnish documentation supporting their portion.
- Modifier FS is required on the claim.
Split/shared does not apply in office settings (incident-to is the office equivalent). Split/shared does not apply to critical care above its own carve-outs. The interaction between split/shared and teaching physician rules requires careful workflow design in academic medical centers.
Use this in your workspace
D3rx assembles the documentation linked to this regulation, walks the practical decisions in plain English, and stores the artifacts against the .gov sources cited above. It is an administrative research aid, not a substitute for counsel.
Related regulations
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- RegulationMLN: 2021 E/M Office Visit Coding RevisionsReference to the 2021 CPT E/M office visit (99202-99215) code revisions: history and exam no longer used for code selection; medical decision making or time controls.
- RegulationMLN: 'Incident To' Services in Medicare Part BReference to Medicare's incident-to billing rules permitting auxiliary personnel to furnish services billed under the physician's NPI, with strict supervision and treatment-plan requirements.
- RegulationCMS-855I: Medicare Enrollment Application for Individual Physicians and Non-Physician PractitionersIndividual Medicare enrollment vehicle for physicians, NPPs, and certain other individual suppliers; required for any clinician billing Medicare under their own name.
- RegulationMLN: High-Frequency Medicare Modifier ReferenceReference to the modifiers most commonly used in Medicare professional billing: 25, 26, 50, 51, 57, 58, 59, 76, 77, 78, 79, 80, 82, and the X{EPSU} series.
- RegulationNCCI Bilateral Procedure Reporting RulesMedicare's policy for reporting bilateral procedures uses the MPFS Bilateral Indicator (0, 1, 2, 3, 9) and depends on whether the code descriptor already includes both sides.
- RegulationMLN: Advance Beneficiary Notice of Noncoverage (ABN, CMS-R-131)Reference to Medicare's ABN form required before furnishing items or services Medicare may not cover, shifting financial responsibility to the beneficiary.
- RegulationMLN: Medical Necessity — Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs)Reference to Medicare's coverage determinations: NCDs are issued by CMS; LCDs are issued by MACs; both define when an item or service is reasonable and necessary.
- RegulationMLN: 60-Day Overpayment Refund Rule (42 USC 1320a-7k(d))Reference to the ACA-added requirement that a Medicare or Medicaid overpayment be reported and returned within 60 days of identification, with FCA exposure for retention beyond that window.
Last reviewed May 23, 2026 · Citation verified May 23, 2026
Research aid, not legal advice. This summary is an administrative research aid prepared by D3rx. It does not certify compliance, provide legal advice, replace counsel, or guarantee an audit outcome. For authoritative regulatory text follow the primary source link at the top of this page. The practice remains responsible for reviewing, adopting, and maintaining its compliance program.