Physical Therapy and Locum Tenens

May 22, 2017
Rick Gawenda

The Centers for Medicare and Medicaid Services (CMS) will implement section 16006 of the 21st Century Cures Act that allows outpatient physical therapy services furnished by physical therapists 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. Does one need to qualify as both HPSA & MUA in order to take advantage of Locum Tenens? Our clinics are in an MUA, but not HPSA.

      1. Just bill out with appropriate modifier? Q5 or Q6. We do have a PT our on Maternity leave so this would be benefitial. And is there any time limits for billing with these modifiers?

        1. Please read the transmittal associated with the article. CMS tells you what modifier must be attached to the procedure codes on the claim form.

  2. Does this only apply to physical therapy? What about occupational therapy? Can you have a locum for OT?

  3. We are located in a primary HPSA. Does this apply for private insurance companies like BCBS as well.

    Also, our clinic has two PT’s, if one PT is present in clinic with the locum tenes, can that PT co-sign the note to ensure payment (if the locum is not credentialed at our facility)?

    1. This article only addresses the Medicare program and outpatient therapy. You would need to check with other insurance carriers regarding the use of non-credentialed therapists.

  4. Would you be able to use a “locum tenen” for a clinic with staffing issues? Say to fill a short assignment until you find a full-time replacement? If so, how would you go about billing for a therapist filling in for someone who is no longer there?