Locum Tenens Frequently Asked Questions

Question: When billing for a Locum Tenens, which physician’s name should be on the claim?

Answer: Enter the regular physician's (absent) NPI in box 24 J of the CMS-1500 form or electronic equivalent.

Question: Can a physician work one shift a month and be considered Locum Tenens?

Answer: No. It appears the physician is regularly scheduled for one shift a month. Physicians may retain substitute physicians to take over their professional practices when they are absent for reasons such as illness, pregnancy, vacation or continuing medical education. It is not appropriate to bill Locum Tenens for longer than 60 days.

Question: A provider left our group. We have billed Locum Tenens for 60 days. If we use a different substitute physician every 60 days, can we continue to bill Locum Tenens under the exiting physician’s National Provider Identifier (NPI)?

Answer: No, it is not appropriate to bill Locum Tenens for longer than 60 days, even if a different substitute physician is providing the service. Group practices may bill for a temporary replacement under the exiting physician’s NPI for up to 60 days.

Question: What does Palmetto GBA consider sufficient documentation to support a Locum Tenens service was rendered?

Answer: If a Locum Tenens service was rendered and the Q6 HCPCS modifier was appended to the claim, we would need to see documentation (would not be within the progress note) that substantiates a Locum Tenens Arrangement has occurred. This may be a contract, etc.

Question: How do we show that the regular physician has been called to military duty and need to use a Locum Tenens for longer than 60 days?

Answer: We would need to see documentation indicating he/she was called to military duty.

Question: If a physician is on vacation and another physician is covering (not a member of the practice), can the covering physician supervise and bill "incident to?"

Answer: No. To qualify as "incident to" the services must be provided by a caregiver qualified to provide the service, whom you directly supervise, and who represents a direct financial expense to you (such as a W-2 or leased employee, or an independent contractor). It must be part of the patient's normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the course of treatment.

Question: If a nurse practitioner in our office leaves temporarily due to an illness, can a Locum Tenens physician take her place while she is gone?

Answer; No. Services of nonphysician practitioners (e.g., CRNAs, NPs and PAs) may not be billed under the Locum Tenens or Reciprocal Billing reassignment exceptions. These provisions apply only to physicians.

Question: If a physician leaves the practice to be employed by a different practice, would the Locum Tenens still bill under the physician that has left or under his own NPI?

Answer: Group practices may bill for a temporary replacement under the exiting physician’s NPI for up to 60 days.

Question: Can we bill Locum Tenens for an on call physician who covers on the weekend?

Answer: No. Physicians may retain substitute physicians to take over their professional practices when they are absent for reasons such as illness, pregnancy, vacation or continuing medical education. It is not appropriate to bill Locum Tenens for longer than 60 days.

Question: When a Locum Tenens evaluates a patient is it considered a new patient?

Answer: No. The service is billed under the regular physician’s NPI. If the regular physician or a provider in the group of the same specialty has seen the patient in the past three years it is considered an established patient. 

Resource: Internet Only Manual (PDF, 1.59 MB), Locum Tenens: Pub. 100-04, Chapter 1, 30.2.10 and 30.2.11.

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 

Click to Chat Now