Prolonged Services Billed As a Split/Shared Visit

by  Raquel Shumway
Feb 24th, 2022

Previously prolonged services were not allowed to be billed as a split or shared visit. However, Medicare's 2022 Medicare Physician Fee Schedule Final Rule has updated that ruling to allow add-on codes for prolonged services to be reported as a split or shared visit. If all requirements for reporting a prolonged service are met, then the time spent by both the physician and the NPP can be reported. 

Note: The time of both providers must meet the threshold for reporting prolonged E/M services (60 or more minutes beyond the typical time of the primary service code

It has been determined that in order to report prolonged services as a split or shared visit, the physician or NPP that has performed the substantive (i.e., majority) portion of the service will do the reporting. The reporting physician/NPP will report BOTH the primary service and the prolonged service. 

For shared office/outpatient visits the substantive portion of the service can be determined by either:

• Time (total of primary service and prolonged service by both the physician and the NPP):
  The provider who spent the majority of the time providing the service reports
• key component: The provider who performed the primary service

This option is the valid for the year 2022 and only for office/outpatient visits. See the CMS table below for more information as to what codes to use and what rules apply to each year. Beginning in year 2023 the substantive portion must be determined by time only.  

Table 26: Final Definition of Substantive Portion for E/M Visit Code Families E/M Visit Code Family 2022 2023 If Substantitive Portion is a Key Component . . . If Substantive Portion is Time . . . Substantive Portion Must Be Time Other Outpatient* Combined time of both practitioners must meet the threshold for reporting HCPCS G2212  Combined time of both practitioners must meet the threshold for reporting HCPCS G2212  Combined time of both practitioners must meet the threshold for reporting HCPCS G2212 Inpatient/Observation/Hospital/Nursing Facility Combined time of both practitioners must meet the threshold for reporting CPT 99354-9 (60+ minutes > typical) Combined time of both practitioners must meet the threshold for reporting CPT 99354-9 (60+ minutes > typical) Combined time of both practitioners must meet the threshold for reporting prolonged services Emergency Department N/A N/A N/A Critical Care N/A N/A N/A Acronyms: E/M (Evaluation and Management). *Office visits will not be billable as split (or shared) services.

 

For more information on these subjects and the final rule please see the following:

• Split/Shared Visits No Longer Specific to Medicare Plans in 2022
• Critical Care

References

•  Medicare’s 2022 Medicare Physician Fee Schedule Final Rule (MPFS)