When can a physician bill for a shared/split visit in an office setting?

Billing for a shared or split visit in an office setting allows for both a physician and a non-physician practitioner (NPP) to participate in the same visit, enabling them to collaboratively provide care for a patient. The service must meet specific criteria known as "incident-to" requirements, which stipulate that the NPP's services must be an integral part of the physician's overall treatment plan and provided under the physician's direct supervision.

Under these incident-to rules, the physician must be actively involved in the patient's care, and the visit must be conducted in a manner that is consistent with their treatment plan. For billing purposes, the NPP must provide services that are ordinarily performed by the physician, and the physician must be available, although not necessarily present during the entire patient encounter. This ensures that the billing reflects the collaborative nature of the care provided without compromising the level of medical oversight required.

This practice ensures that the physician can legitimately bill for their component of the visit while adhering to the regulations set forth by Medicare and other payers about care delivery and supervision.