Overview
CMS describes Shared Medical Appointments (SMAs) as voluntary group visits for patients with a common chronic condition, addressing both clinical care and social isolation. In 2026, there isn’t a specific code for this service, but CMS is proposing one for 2027.
These SMAs are provided for patients who have an existing relationship with the practitioner or a same-specialty partner, give explicit consent, and have a shared medical condition. The number of participants is capped at 10 patients, and the session is a minimum of 60 minutes.
The proposed new code, a placeholder code, GSMAS: Voluntary, group-based medical session involving multiple patients with common medical condition(s), receiving medical care in a group setting; billed and led by a physician or qualified nonphysician practitioner and may include services provided by other qualified healthcare professionals, clinical staff, or auxiliary personnel under the direction of the supervising physician or other practitioner. Session integrates group education, counseling, and peer support with individualized patient clinical assessment and care, 2-10 patients, billed once per patient, per session.
The HCPCS code would be the only service billed for the group meeting, and billed under the physician or NPP provider number. The physician or NPP would need to have a private, individual meeting with the patient.
Conditions eligible for SMAs
The types of conditions that are eligible as the focus of shared medical appointments are those that are amenable to lifestyle interventions. Those that are typically cited include diabetes, cardiovascular disease, hyperlipidemia and obesity. When considering whether a condition would be eligible for this type of visit, ask this question: would making lifestyle changes improve the patient’s condition and outcome?
Why groups work
These groups are shown to be effective because the longer appointment time allows for better management. Trust is increased with the health care team. In addition to strategies for lifestyle changes, these groups combat isolation and loneliness. Patients benefit from the social interaction and gain perspective about the disease and what they can do to improve their health status.
Groups
The nature of the intervention is a group, composed of multiple patients with the same diagnosis. The group should be set up with norms that support confidentiality, respectful interactions, and willingness to participate and share. Patients and practitioners can share experiences, strategies and resources that will improve individual patient self-management. CMS is defining the code as at least 60 minutes. There’s no additional charge for a group meeting that is longer than 60 minutes.
CMS proposed rules:
- Patient is an established patient to the physician/NPP or to their same specialty partner
- Specific consent for the group
- Specific consent agreeing to confidentiality
- Group size 2-10, 10 maximum participants
- 60-minute sessions
- May be performed via telehealth
Professionals lead the group
The model that CMS is adopting is one led by two professionals. One of the professionals is a physician or non-physician practitioner who has E/M in their scope of practice. The service is reported under that practitioner’s provider number. The second professional could be a nutritionist or dietitian, health coach, behavioral health specialist, pharmacist or nurse. Only the code for the shared medical appointment is reported, not an additional code for the other professional who co-leads the group.
CMS proposed rules:
- Session led by a physician, NP or PA and may have ancillary staff help “when the provider is meeting with patients individually.” P. 188 Display copy
- HCPCS code billed once per patient.
- No separate billing for other professionals (dieticians, etc) who co-lead the group
Individual meetings with each patient
The physician or NPP who is co-leading the group meets with each patient individually, privately. This happens during the group time, while the other professional is facilitating the group. This individual service could include a brief history, a focused exam, review of labs, goals and progress, prescription management and ordering future labs. The nature of the individual meeting is not prescribed in the code as proposed.
CMS proposed rules for components of SMA
- E/M elements; individualized clinical care with medical documentation
- Education, based on evidence-based content
- Discussion of positive lifestyle changes
Documentation
Where there is a service, there is a note documenting the service. Each individual record should reflect what was discussed by the group at that meeting. This would include what the agenda item or topic was for the meeting, how the discussion progressed and take away assignments. This part of the documentation would be the same for each group member.
There needs to be individualized documentation for each patient. This could include a statement of their participation in the group. And it should include a description of the individual appointment between the patient and the physician or NPP. “While a SMA may include up to 10 beneficiaries in a 60-minute session, the individualized care for a participating beneficiary may vary, such that some beneficiaries may receive more or less individualized care than others; nonetheless, documentation in the medical record must reflect the specific services that the individual beneficiary received during the SMA session.” Display copy, p. 190-191
CMS proposed rules:
- Each session must be documented in each participant’s medical record
- “Each beneficiary receives individualized clinical care, and the medical record must reflect the specific services that the individual beneficiary received during the SMA session.” Page 186, Display copy, Proposed Rule
Separate visit? Up for discussion.
“In the event it is medically necessary for a beneficiary to receive an E/M visit on the same day as a SMA by the same physician or other qualified health professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, we propose that any time and effort cannot be counted more than once. We propose not to consider and treat this as two E/M same-day visits and seek public comment on this proposal. Additionally, we seek comments on what components must be required for each SMA session.” Display copy, p. 189