Shared/Split Visits: 2024 Rules

In the 2024 Final Rule, CMS changed the criteria for a “Substantive” portion for Shared/Split services. The substantive portion defines who gets to report the E/M service based on who met the criteria, remainder of the Split/Shared guidelines remain unchanged. You still need to be in the same group practice and the service has to occur on the same calendar day. Novitas has the Shared/Split guidelines on their page.

Substantive Portion Criteria:

A.  Either document the substantive portion of the (MDM), or

B.  Document that you spent >50% of the combined total time reported

1. Critical Care –  Substantive Portion =  >50% of the total time only.
2. Emergency Department – Substantive Portion =  MDM only.
3. Activities that contribute to the total time are the same as what was implemented by CPT for the office/clinic setting in 2021.
4. CMS delayed the implementation for using time only to determine the substantive portion.

The AAPC shared examples of documenting the substantive portion in their Updates Clarify Medicare Split/Shared article.

“I provided the substantive portion of the care of this patient. I personally performed the (MDM) for this encounter.”  Include documentation of the MDM to the extent needed to support the assigned E/M code.)

“I provided a substantive portion of the care of this patient. I personally provided more than half of the (total time) dedicated to the treatment of this patient.” Include both provider times, whomever has more than half, may report the service.

Modifier -FS (Shared/Split E/M visit) must be appended to the E/M CPT code on Medicare claims.

There are several very informative fact sheets (MSHBC) that you may find helpful out there. CodingIntel published one (here). You may need to create a login (free) to access it. I have also included other resources for your review below.

Shared/Split Resource Sheets:

• • Novitas Split/Shared Page
  • Transmittal 11288 Shared Visit Changes
  • Shared Prolonged Services (currently being updated)
  • Shared Critical Care Services
  • Shared Facility Setting E/M Services
  • Quick Tips Sheet
  • IM At-a-Glance News Blast
  • MSHBC (internal) Shared/Split Infographic

 

Article revised 09/12/2023 with AAPC substantive portion language.

Contact for more information:

[email protected] or [email protected]. You can also reach out to your departmental compliance liaison listed under our “Meet the Team” tab.