Corporate

November 9, 2012 - Revised: 09.29.15

Services Provided Under Locum Tenens Provisions

The practice of retaining a substitute physician when the regular physician is away from the practice is known as “locum tenens,” for Medicare purposes. Under the locum tenens provisions of Medicare, the regular physician’s absence (and the need for a locum tenens physician) may be due to reason such as illness, pregnancy, vacation, or continuing medical education.

In these situations, services performed by the substitute physician may be submitted and paid under the regular physician’s National Provider Identifier (NPI). The “regular physician” is considered the physician that is normally scheduled to see a patient and may be a primary care physician or a specialist.

Claim Submission Guidelines

CMS guidelines specify that, in order to submit a claim under the locum tenens provisions, all of the following criteria must be met:

  • The regular physician is unavailable to provide the visit services (due to absence for illness, vacation, etc.).
  • The Medicare beneficiary has arranged or seeks to receive the visit services from the regular physician.
  • The regular physician pays the locum tenens for his/her services on a per diem or similar fee-for-time basis (note: this arrangement is between the regular physician and the substitute physician, and is not presided over by Medicare).
  • The substitute physician does not provide the visit services to Medicare patients over a continuous period of longer than 60 days.
  • Submit the locum tenens services under the regular physician’s NPI with HCPCS code modifier Q6 (service furnished by a locum tenens physician).

Please note: documentation in the patient’s medical record should clearly show who actually rendered the service, as the claim itself will reflect the NPI of the regular physician.

Provider Enrollment and Locum Tenens

  • In true “locum tenens” situations, do not enroll the locum tenens physician through the Medicare Provider Enrollment process.
  • If you anticipate that the locum tenens physician will provide services for longer than 60 days, follow the normal Provider Enrollment guidelines and submit the appropriate CMS-855 forms to enroll the physician and reassign his/her benefits to the group, if appropriate.

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