04/12/2024

ASCO Coding Tip of the Month: April 2024

A visit in the hospital setting that is ”split” or “shared” by a physician or non-physician practitioner is subject to split/share billing guidelines.  In 2024, CMS finalized their guidelines to split/shared billing to reflect changes enacted in the 2024 AMA CPT manual.  In 2024, split/share service levels are determined by:

• Time: The practitioner spending the majority of time with the patient.
• Medical decision-making: The reporting provider performs the substantive portion of the medical decision-making, as defined by guideline instruction.
• Modifier -FS should be appended to the split/shared visit code.

ASCO’s Coverage and Reimbursement resource on Split/Share E/M Services was updated to include more details on split/share billing, including updates, reporting criteria for time and medical decision making, and documentation requirements. Not all payers accept split/share billing.  Please refer to individual payer policy for coverage.

New, revised and deleted J Codes for 4-2024

2024-April-HCPCS-Updates.pdf