skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. Information for Medicare beneficiaries is only available on the medicare.gov website.
En Español
Text Size:
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 5/1/2018 Location: FL, PR, USVI Business: Part A, Part B

Split-shared visit or "incident to" FAQ

Q. If a physician's assistant (PA) gathers initial information and the physician performs the examination and medical decision making, but the PA dictates the office note, do both the physician and PA need to sign the record for proper documentation?
A. This depends on whether the service is a split/shared visit or if the visit is considered "incident to."
When an evaluation and management (E/M) service is a split/shared encounter between a physician and a non-physician practitioner (NPP), the service is considered to have been performed incident to the physician if the requirements for "incident to" are met and the patient is an established patient. If "incident to" requirements are not met for the split/shared E/M service, the service must be billed under the NPP's national provider identifier (NPI).
A split/shared E/M visit is defined by Medicare as a medically necessary encounter with a patient where the physician and a qualified NPP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service. A substantive portion of an E/M visit involves all or some portion of the history, examination or medical decision making key components of an E/M service. The physician and the qualified NPP must be in the same group practice or be employed by the same employer.
If the physician's signature is the only signature on the visit, Medicare assumes that he/she is indicating they personally performed the visit. Notes recorded in the patient's medical records by another provider are considered relevant documentation of the encounter. Documentation may be dictated and typed or hand-written, or computer-generated and typed or handwritten. Documentation must be dated and include a legible signature or identity.
Source: The Centers for Medicare & Medicaid Services (CMS) internet-only manual (IOM) Pub. 100-04 Medicare Claims Processing Manual, Chapter 12, Section 30.6.1 external pdf file;
Medicare Learning Network® (MLN®) Global Surgery Fact Sheet external pdf file
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.