It is common for physicians and other qualified health care professionals (QHCPs) who may provide and bill for evaluation and management (E/M) services to work as a team in providing patient care. Often, a physician and a QHCP of the same group practice will provide different but substantive and medically necessary portions of an E/M service on the same date. This is referred to as a split/shared service. A split/shared service may be billed by the physician or QHCP, but payment may be greater when billed by the physician (eg, Medicare pays QHCPs 85% of physician rate).

The split/shared concept and rules for reporting have been mainly defined by the Centers for Medicare & Medicaid Services (CMS) for the Medicare program. However, many Medicaid and private payer plans have adopted this terminology and the requirements for documentation and reporting established by the CMS. It is important to understand when split/shared...

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