Medicare has specific rules for billing for Nurse Practitioners, Physician Assistants as shared services in the hospital. These rules are explained in this article.
Evaluation and Management services which are shared or split encounters between a physician and a qualified Non-Physician Practitioner (NPP.) Medicare rule
A physician and an NPP can provide shared E/M services in the hospital (inpatient, ED or outpatient department). Each of the clinicians must have a face-to-face service with the patient and each must document a clinically relevant portion of the notes. The practice can bill the service under the physician provider number and be paid at 100% of the physician fee schedule. Office visits may only be billed as shared visits when they meet the incident-to guidelines.
E/M codes. 99221–99239
Coverage | Shared Visits
Shared visit rules are Medicare rules.
- Inpatient, outpatient dept, or ED
- Both the physician and NPP must have a face-to-face service
- Both must document their own participation in the patient’s care
- Then, may bill under the physician’s provider number
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