Billing for split/shared evaluation and management service
If you are a physician working at a private medical facility, you may be cooperating with your colleagues when it comes to determining a patient’s clinical condition and subsequent methods.
Did you know that the CMS pays for split evaluation and management services performed in a facility setting?
According to the 2022 Physician Fee Schedule, an E/M visit in a facility setting that is performed in part by a Physician and an NPP who are in the same group can be deemed as a split evaluation and management service. Such services are payable, and they be performed both in-person and via telemedicine by practitioners from a single facility and/or physician group. Split E/M service must be billed under the provider who performed “the substantive portion” of the encounter, i.e. more than half of the total time dedicated to the patient encounter, or a key service component performed by a particular physician. Services jointly reported under a physician’s NPI are paid higher than those billed by a physician assistant.
Now comes the question – how to bill split/shared evaluation and management visits?
CPT 99202–99215, which are regular office visit codes, can be billed as shared services in a facility setting, but in an outpatient department.
Healthcare providers are required to demonstrate a strong medical necessity and specificity of such services by documenting the names of both practitioners who rendered them. More importantly, you need to append a modifier FS on your claims billed for split/shared evaluation and management visits.
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