Split/Shared Visit Billing in 2026: How to Define the Substantive Portion
For 2026, CMS finalized that the "substantive portion" of a split/shared visit can be based on time OR medical decision-making. Here is what that means for facility billing and how to document it correctly.
Split/shared billing decides who bills when a physician and an NP or PA both touch the same facility encounter. For years the rules ping-ponged. For 2026, CMS finally settled it: the substantive portion can be based on time or medical decision-making — giving practices flexibility, if they document it right.
What a split/shared visit is
It's a single E/M service performed jointly, in a facility setting, by two practitioners from the same group — typically a physician and a non-physician practitioner. Only one of them reports the visit, and the choice hinges entirely on who did the "substantive portion."
The 2026 substantive-portion rule
For CY2026, CMS finalized that the substantive portion is whichever of these you choose to rely on:
- More than half of the total time spent by the two practitioners, or
- A substantive part of the medical decision-making (MDM) — the practitioner who performs and approves the MDM.
Time or MDM — you pick the basis that reflects who really drove the visit. That flexibility is the headline for 2026.
Documentation that supports the claim
Whichever basis you use, the note must identify both individuals who performed the service, make clear who performed the substantive portion, and be signed and dated by the billing practitioner. If you rely on time, remember that jointly spent time is counted once, not twice.
Pitfalls to avoid
Don't double-count joint time. Don't bill split/shared in a non-facility (office) setting — that's incident-to territory instead (see our incident-to guide and the 85% rule). And don't leave the substantive-portion basis ambiguous in the note — auditors will ask. Clean, consistent documentation is what disciplined coding support enforces.
Getting split/shared right in your facility?
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The bottom line
2026 gives split/shared billing something rare: a clear, flexible rule. Choose time or MDM, name both practitioners, show who did the substantive portion, and sign. Get that right and facility E/M revenue is captured cleanly and defensibly. Start with a free billing audit.
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Frequently asked questions
A split (or shared) visit is an E/M service performed jointly by a physician and a non-physician practitioner from the same group in a facility setting. Only one of them bills, based on who performed the substantive portion.
For CY2026, CMS finalized that the substantive portion is either more than half of the total time, or a substantive part of the medical decision-making (MDM). Practices can use whichever basis fits — time or MDM.
No. When time is the basis, time spent jointly with the patient by both practitioners is counted only once, not doubled.
The record must identify both individuals who performed the service, show who performed the substantive portion, and be signed and dated by the billing practitioner.
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