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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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Last revised December 28, 2020 - Betsy Nicoletti
Tags: medicare incident-to and shared services, primary care

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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