Shared Visits – Medicare

Medicare has specific rules for billing for nurse practitioners and physician assistants using shared services.  These rules are explained in this article.

Definition

Evaluation and Management services which are shared or split encounters between a physician and a qualified Non-Physician Practitioner (NPP.)  In 2021, CPT^® added the concept of shared services for office visits, but this does not change Medicare rules.

Explanation

A physician and an NPP can provide shared E/M services in the hospital (inpatient, ED or outpatient department). Each of the clinicians must have a face-to-face service with the patient and each must document a clinically relevant portion of the notes. The practice can bill the service under the physician provider number and be paid at 100% of the physician fee schedule. Office visits may only be billed as shared visits when they meet the incident-to guidelines.

Codes

The rules described below are Medicare rules.

• May be done in inpatient, outpatient department, or ED
• May be done in the office, only if the service meets incident-to rules
• Both the physician and NPP must have a face-to-face service
• Both must document their own participation in the patient’s care

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