42 CFR 415.140 – Conditions for payment: Split (or shared) visits
(a) Definitions. For purposes of this section, the following definitions apply:
Facility setting for purposes of this section means institutional settings in which payment for services and supplies furnished incident to a physician or practitioner’s professional services is prohibited under § 410.26(b)(1) of this subchapter.
Split (or shared) visit means an evaluation and management (E/M) visit in the facility setting that is performed in part by both a physician and a nonphysician practitioner who are in the same group, in accordance with applicable law and regulations such that the service could be could be billed by either the physician or nonphysician practitioner if furnished independently by only one of them.
Substantive portion means more than half of the total time spent by the physician and nonphysician practitioner performing the split (or shared) visit, or a substantive part of the medical decision making except as otherwise provided in this paragraph. For critical care visits, substantive portion means more than half of the total time spent by the physician and nonphysician practitioner performing the split (or shared) visit.
(b) Conditions of payment. For purposes of this section, the following conditions of payment apply:
(1) Substantive portion of split (or shared) visit. In general, payment is made to the physician or nonphysician practitioner who performs the substantive portion of the split (or shared) visit.
(2) Medical record documentation. Documentation in the medical record must identify the physician and nonphysician practitioner who performed the visit. The individual who performed the substantive portion of the visit (and therefore bills for the visit) must sign and date the medical record.
(3) Claim modifier. The designated modifier must be included on the claim to identify that the service was a split (or shared) visit.