Billing Medicare for Locum Tenens

Locum tenens, or substitute, physicians usually assume professional practices in the absence of a regular physician for reasons such as illness, pregnancy, vacation, or continuing medical education.

The substitute physicians generally have no practice of their own and move from area to area as needed. Medicare rules require that a locum tenens cannot provide services for longer than 60 continuous days at a time for another physician (unless the other physician has been called or ordered to active duty as a member of a reserve component of the armed forces see  see section 1842(b)(6)(D) of the Social Security Act). The regular physician generally pays the locum tenens a fixed per-diem amount, with the locum tenens having the status of an independent contractor rather than an employee.

The regular physician may submit the claim using the Q6 modifier (services furnished by a locum tenens physician). Additionally, the regular physician must keep on file a record of each service provided by the locum tenens along with the locum tenens' National Provider Identifier. Find all the details in the Medicare A/B Reference Manual, 12.4 Reciprocal and Locum Tenens Billing Arrangements.

Under reciprocal billing arrangements, a patient's regular physician may submit a claim and receive payment for the services arranged to be provided by a substitute physician on an occasional basis. The regular physician should identify the service as substitute physician services and bill with the Q5 modifier (service furnished by a substitute physician under a reciprocal billing arrangement).

For commercial payers, the requirements may vary, making it necessary to determine billing procedures on a payer-by-payer basis.

Updated Aug. 13, 2013 

TMA Practice E-tips main page