Shared Medical Appointment: Part 1 – Physician/APP Role

Shared Medical Appointments (SMAs) represent a shift from siloed care to intentionally coordinated, team‑based encounters—without collapsing medical decision‑making into a group service. For physicians and advanced practice providers (APPs), the SMA model preserves the integrity of the individual evaluation and management (E/M) visit while creating space for behavioral and nutritional interventions to occur alongside, rather than within, the medical service. Understanding the physician/APP role is foundational to building an SMA that is both clinically effective and billing‑compliant.

PHYSICIAN / APP ROLE

Service Type: Individual Medical Evaluation & Management
Typical CPT: 99213–99215
Key Characteristics:

• Individual medical decision‑making.
• May occur before, during, or after group portion.
• Can occur in a group-observed setting.
• May be split/shared with NP/PA if allowed (E/M only).

✅ Bills E/M ✅ Uses MDM or time ❌ Does not bill group education

DOCUMENTATION REQUIREMENTS

VISIT HEADER (REQUIRED)

Visit Type: Shared Medical Appointment – Medical + Behavioral Intervention + Nutrition
Place of Service: ☐ Hospital Outpatient ☐ Clinic ☐ Other: _____
Date of Service: __________
Other Participants Present: Other SMA patients present (names not documented per HIPAA)

MEDICAL E/M NOTE (Physician / APP)

✅ Only required if billing an E/M

Rendering Provider: __________________ (MD/DO/NP/PA)
Billing Code: 9920_ / 9921_ (+ modifier -25 if applicable)

Chief Complaint

Follow‑up of chronic medical condition(s) with integrated behavioral support.

History / Interval Update

• Relevant condition(s): _____________________
• Impact on function/adherence/symptoms:
  • ☐ Pain
  • ☐ Glycemic control
  • ☐ Medication adherence
  • ☐ Sleep
  • ☐ Other: __________

Medical Decision Making (MDM)

• Problems addressed: _____________________
• Data reviewed: _____________________
• Risk: ☐ Low ☐ Moderate ☐ High

Assessment & Plan (Medical)

• Medical treatment decisions made independently for this patient
• Medications adjusted / ordered
• Referrals if applicable

Time (if time‑based)

Physician/APP spent ___ minutes of total time on the individual medical portion of today’s visit.

ATTESTATION (Recommended, but not required)

“The medical E/M visit was distinct from the behavioral and nutritional interventions. I addressed separate components of care that was medically necessary for the condition treated today.”

CRITICAL COMPLIANCE SAFEGUARDS 

✅ Allowed

• 3 providers → 3 distinct billed services
• Same‑day billing when services are separate
• Group presence without group billing (E/M)
• RD billing alongside MD + BH

🚫 Not Allowed

• Time overlap between providers
• Billing education only
• Billing RD services as E/M
• Splitting behavioral therapy
• Blending documentation

Shared Medical Appointments may include a physician/APP, behavioral health clinician, and registered dietitian in the same encounter when each provider delivers a distinct, medically necessary service supported by separate documentation and billing, with no overlap of time or scope.

HOW THIS LOOKS IN EPIC

Encounter: Shared Medical Appointment
Notes Created:

• MD/APP: Individual E/M Note
• BH Clinician: Behavioral Intervention Note
• RD: MNT Note

Charges:

• Each provider drops their own CPT
• No shared charge lines
• Independent diagnoses

This structure passes Medicare, Texas Medicaid, and commercial audits when followed as written.

Shared Medical Appointment: Part 2 – Behavioral Health Clinician Role