Split/shared services are evaluation and management services (E/M) services performed jointly between a physician and a non-physician practitioner (NPP), also called advanced practice nurses or physician assistants. CMS pays services performed by physicians at 100% of the physician fee schedule amount and services performed by NPPs at 85% of the fee schedule amount. When services are shared between those professionals, CMS requires that the claim is submitted by the practitioner who has performed by the practitioner who has performed the substantive portion of the service. What defines the substantive portion? Download the reference sheet and be sure.
July 19, 2023 update for 2024: CMS is proposing to continue the 2022/2023 definition of the substantive portion of the visit for 2024. They indicated this in the 2024 Proposed Rule, released 7/13/2023. We’ll know for sure when we see the Final Rule in November.
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