Locum Tenens

WPS Medicare has received clarification from the Centers for Medicare & Medicaid Services (CMS) Central Office for locum tenens billing based on the CMS Internet-Only Manual, Publication 100-04, Chapter 1, section 30.2.11. Previously, WPS Medicare published a Frequently Asked Question (FAQ) on locum tenens in the November 2009 edition of the Communiqué. The following information replaces the FAQ previously published.

A patient's regular physician may receive Medicare Part B payment for covered services of a locum tenens physician who is not an employee of the regular physician. One of the Medicare conditions for locum tenens services is that the substitute physician may not provide services to Medicare patients over a continuous period of longer than 60 days. Current Medicare policy allows physicians to cover absences of longer than 60 days by hiring multiple substitute physicians. For example, if a physician needs to be absent from his or her medical practice for 120 days, the absent physician may hire one locum tenens physician to work the first 60-day period and a different locum tenens physician to work the second 60-day period. The 60-day clock starts over when the regular physician returns to work.

The CMS has advised contractors when a physician permanently leaves a medical group, the medical group should not bill with a Q6 (service furnished by a locum tenens physician) or Q5 (service furnished by a substitute physician under a reciprocal billing arrangement) modifier for services furnished by a temporary physician. The temporary physician is not substituting for a regular physician of the medical group; but instead, is filling a staffing void.

The CMS stated, "This is not the intent of the substitute physician billing arrangements. Although, the manual states that a locum tenens physician can be used for up to 60 continuous days when a physician leaves a medical group, we believe that this is an incorrect use of the locum tenens rules and will correct this statement in a future manual change."

There is no limit for locum tenens physicians substituting for doctors being called to active duty in the Armed Forces. Congress passed an exception to the 60-day limit for physicians being called to active duty in the Armed Forces. The armed services exception has been added to the statute in section 1842(b)(6) on a permanent basis. The manual will reflect this change in a future update. Reference: http://www.ssa.gov/OP_Home/ssact/title18/1842.htm

For additional information on locum tenens, please refer to the CMS Internet-Only Manual, Publication 100-04, Chapter 1, section 30.2.11, on the CMS Website .

Page Last Updated: Monday, 08-Feb-2010 08:23:39 CST