The term “shared visit” is used when both a physician and a nurse practitioner or physician assistant jointly participate in the evaluation and management (E/M) of a patient. Shared visits apply to E/M services but not to procedures.

A visit may be billed under the physician when the physician performs the substantive portion, defined as more than half of the encounter by key elements of medical decision making (MDM). CPT describes the substantive portion using the following examples, when documented by the physician:

Making or approving the complexity of problems addressed (COPA); and

Accepting responsibility for the risk of complications, morbidity, or mortality.

By completing two of the three MDM categories (COPA, data, or risk), the physician meets the CPT threshold for the substantive portion.

For such time-based services as critical care, the Centers for Medicare and Medicaid Services (CMS) requires that the total time be at least 30 minutes and that the billing clinician provide more than 50 percent of the total time. (See ACEP FAQ #9)

This framework reflects CMS’s move toward team-based care, recognizing the collaborative roles of physicians, nurse practitioners, and physician assistants. Precise, explicit documentation remains essential for accurate billing, regulatory compliance, and clarity of shared clinical responsibility.

Jason Adler, MD, CEDC, FACEP, is the Senior Vice President of Coding at LogixHealth and is the current ICD-10 workgroup chair for ACEP’s Coding and Nomenclature Advisory Committee. Dr. Adler is a certified ED Coder and Clinical Associate Professor of Emergency Medicine at the University of Maryland Residency Program, serving as Director of Compliance and Reimbursement.