• When to Bill for Locum Tenens


    Be sure you are not billing physicians joining your practice as locum tenens. The Centers for Medicare & Medicaid Services defines locum tenens physicians as those who have no practice of their own; they can provide care for your patients at your office for no more than 60 days.

    This rule allows physicians who need time away from their practice to contract with a locum tenens physician to oversee their patients.

    When your practice contracts with a locum tenens physician, the owner physician is required to keep records on file for each service provided by the locum tenens physician and have it accessible to CMS upon request.

    Submit claims using the owner physician's NPI number, but append “modifier-Q6 Services furnished by a locum tenens physician under a reciprocal billing arrangement” to each exam, test or surgery the locum tenens physician performs.

    When the covering physician has his or her own practice, append “modifier -Q5 Service furnished by a substitute physician under a reciprocal billing arrangement.”

    If a new physician has yet to be credentialed with payers, the patient is responsible for services and should be notified ahead of the exam. Do not bill under another physician’s NPI. If another physician of the practice performs key elements of the exam, it is appropriate to bill the payer under the credentialed physician’s NPI.

    For more information, see CMS’ Section 30.2.11 (PDF, 4.3 MB).