decisionhealth Newsletters, Part B News - 2023 Issue 10 (October)
Split visits in the office should follow incident-to rules
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Article Overview
This Q&A discusses Medicare billing guidance for collaborative office visits in the physician office setting and explains how CMS split/shared visit policy differs from facility settings. It is aimed at coders, billers, and practice staff who need to understand which framework applies to office-based E/M encounters and where to look for supporting CMS and CPT guidance.
Why This Topic Matters
Misapplying split/shared visit policy can affect which practitioner bills the encounter and whether the claim aligns with Medicare expectations. The article helps readers identify the governing framework for office-based shared visits and understand the relationship between CMS manuals and CPT guidance.
Article Sections
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Question
Introduces a billing scenario involving a collaborative office visit and asks how the service should be reported.
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Answer
Summarizes the applicable Medicare guidance for office-based shared visits and the broader policy context for split/shared services.
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Resource
Provides a CMS manual reference and source link for further reading.
What You Will Learn
- How CMS guidance distinguishes office-based shared visits from facility split/shared visits.
- How the article frames the relationship between Medicare policy and CPT split/shared visit concepts.
- Where to find the cited CMS manual reference for additional guidance.
- Who generally bills the service in the office scenario discussed.
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Physician assistants
- Physician office staff
- Compliance staff
Codes Discussed
Code Ranges Discussed
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