Medicare Locum Tenens

July 23, 2018
Rick Gawenda

Are you a physical therapist who owns their own practice and wants to take some well-deserved time off and take a vacation? Do you own a physical therapist private practice and employ other physical therapists who will take vacation time or possibly, an extended amount of time off due to an illness or family emergency? If you answered yes to either question, this is an article that you must read.

The Centers for Medicare and Medicaid Services (CMS) has implemented section 16006 of the 21st Century Cures Act that allows outpatient physical therapy services furnished by physical therapists in private practices to be billed under reciprocal billing and fee-for-time compensation arrangements in the same manner as physicians in certain areas of the United States. The term “locum tenens,” which has historically been used in the manual to mean fee-for-time compensation arrangements, is being discontinued because the title of section 16006 of the 21st Century Cures Act uses “locum tenens arrangements” to refer to both fee-for-time compensation arrangements and reciprocal billing arrangements. This will allow physical therapists in certain parts of the country to submit claims under their NPI number to the Medicare program for covered visit services which the regular physical therapist arranges to be provided by a substitute physical therapist on an occasional reciprocal basis.

Effective with dates of service on and after

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  1. If I am reading this correctly, if our clinic physical location is a “yes” for MUA/P area, then we are qualified for a substitute PT at our clinic?

  2. If a therapist is out on maternity leave and no temp therapist was found would she reevaluate her patients or do a progress note upon return after 6 weeks?

    1. It would depend if the criteria for a reevaluation was met. I would also question if a patient went 6 weeks without therapy, do they really need therapy? Also, why would the therapist not refer the patient to another facility if they really needed the therapy?

      1. These patients lives in an ALF. A part time temporary therapist was found but not all patients were able to be seen in her part time hours. Some patients have regressed not having been seen by the therapist for 6 weeks but the weather was too cold to have them leave the facility to go to local clinics. The question is do they qualify for a re-evaluation or does a progress note suffice?

        1. Same response as previous. It would depend if the criteria for a reevaluation was met and the documentation supports the reevaluation.