Split/Shared Physician E/M Service

Billing Rules for Shared E/M Services in Hospital Settings

According to CMS Pub. 100-04, Chapter 12, Section 30.6.1.B, when a hospital inpatient/hospital outpatient or emergency department E/M is shared between a physician and an NPP from the same group practice, and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed under either the physician’s or the NPP’s UPIN/PIN number. However, if there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient’s medical record) then the service may only be billed under the NPP’s UPIN/PIN. Payment will be made at the appropriate physician fee schedule rate based on the UPIN/PIN entered on the claim.