What is the difference between a split/shared visit and incident-to billing?

Setting. Incident-to applies outside hospitals and covered skilled nursing facility stays, typically in the office or clinic, where the physician bills for care staff deliver under direct supervision. In a hospital or skilled nursing facility, where incident-to payment is not allowed, a visit both practitioners worked on is billed as a split (or shared) visit by whoever performed the substantive portion.

What Is a Split (or Shared) Visit?

Split (or shared) visit

Short answer

A split (or shared) visit is a Medicare evaluation and management (E/M) visit in a hospital or other facility setting that a physician and a nonphysician practitioner in the same group each perform part of, billed by whichever of them performed the substantive portion, with modifier FS.

Last reviewed October 30, 2026 by the Remitwright billing team. Editorial policy

Also written assplit/shared visitsplit/shared visitssplit or shared visit

Split (or shared) visits cover the facility setting, where incident-to billing is not available. When a physician and a nonphysician practitioner from the same group both see a patient in a hospital or skilled nursing facility, Medicare lets one of them bill the combined visit and pays the practitioner who performed the substantive portion. The service must be one either of them could have billed if furnished alone, and office visits and nursing facility visits cannot be billed this way.

Since January 1, 2024, the substantive portion means more than half of the total time the two practitioners spent, or a substantive part of the medical decision making as the CPT E/M guidelines define it. Critical care and prolonged services use time only. Only distinct time counts: when the two meet with the patient or discuss the case together, that time is counted once. One of them must see the patient in person, though not necessarily the one who bills. The record must identify both practitioners, and the one who performed the substantive portion signs and dates it.

The claim must carry modifier FS, and Medicare does not pay partial E/M visits, so modifier 52 cannot be used to report one practitioner’s share. Two errors are worth watching for. One is billing under the physician because the physician signed last, when the time record shows the nonphysician practitioner spent most of the time and the physician did not perform the substantive part of the decision making. The other is billing a split visit in the office, where it is not allowed and the incident-to rules apply instead.

Example

Split (or shared) visit in practice

A nurse practitioner spends 25 minutes on a hospital follow-up visit and the hospitalist spends 15 minutes on the same patient that day. The nurse practitioner spent more than half of the 40 minutes, so the visit is billed under the nurse practitioner's NPI with modifier FS. Hypothetical example.

Split (or shared) visit

Split (or shared) visit in practice

A split (or shared) visit is part of Medicare billing, one of the services a dedicated biller runs for you.

Questions about a split (or shared) visit