Now Referred to as: Payment Policies for Reciprocal Billing Arrangements and Fee-For-Time Compensation Arrangements Updates
Provider Types Affected:
This Article is intended for physicians, physical therapists, and other providers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
What You Need to Know:
Outpatient physical therapy services furnished by physical therapists, Provider Specialty 65- in Private Practice located in a Health Professional Shortage Area (HPSA), a Medically Underserved Area (MUA), or in a rural area can be billed under reciprocal billing and fee-for-time compensation arrangements in the same manner as the physicians bill that became effective June 13, 2017.
Guidelines:
Physician for physicians’ services (and services furnished incident to such services) furnished by a second physician to patients of the first physician, and only if the first physician is unavailable to provide the services, and the services are furnished pursuant to an arrangement that is either Informal and reciprocal, or Involves per diem or other fee-for-time compensation for such services.
In addition, the services must not be provided by the second physician over a continuous period of more than 60 days unless the regular physician is called or ordered to active duty as a member of a reserve component of the Armed Forces.
As of June 13, 2017, this same process will be available to Medicare-enrolled physical therapists who use substitute physical therapists to furnish outpatient physical therapy services in a HPSA, MUA, or a rural area.
Modifier Reporting:
MACs allows a physician to submit claims and receive Medicare payments when he/she has arranged for a substitute physician’s services. To report this arrangement, attach the appropriate modifier:
Q5: Service furnished by a substitute physician under a reciprocal billing arrangement
When a locum performs a service or procedure:
Q6: Service furnished by a locum tenens physician
Note: The Q5 and Q6 modifiers’ descriptors will be amended to include physical therapists in addition to physicians in the near future in an HCPCS quarterly update
The official instruction, CR10090, issued to your MAC regarding this change is available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3774CP.pdf. MLN Maters Number: M1090