Using the Q6 Modifier Correctly for Reimbursement

Navigating the complexities of medical billing can be daunting, especially when it comes to locum tenens arrangements. The Q6 modifier, also known as the locum tenens modifier, plays a role in ensuring proper reimbursement when a substitute physician provides care, but its use is limited to specific cases. Proper use of the modifier hinges on knowing when it should (or shouldn’t) be applied. 

What is the Q6 Modifier (i.e. the Locum Tenens Modifier)? 

The Q6 modifier, often referred to as the locum tenens modifier, is a billing code used in medical reimbursement to indicate that a substitute physician provided services. This modifier applies when a regularly scheduled physician hires a locum tenens doctor to temporarily cover their patient load, often due to vacation, illness, or other absences. 

The Q6 modifier ensures that the substitute physician's services are billed under the regular physician's National Provider Identifier (NPI) while adhering to Medicare and payer-specific guidelines.

The Q6 modifier, often referred to as the locum tenens modifier, is a billing code used in medical reimbursement to indicate that a substitute physician provided services.

Should My Facility Use the Q6 Modifier for Locums Staffing? 

It may be tempting to use the Q6 modifier to fill staffing shortages quickly, but it is only appropriate in a narrow set of circumstances. Most importantly, the covering physician must still be credentialed in the vast majority of cases, which means it should not be used to bypass the credentialing process. 

You can use a Q6 modifier if

• The primary physician is on medical or other leave, participating in continuing education, or called into military service. 
• The primary physician has permanently resigned from the practice.
• Coverage will not last longer than 60 days.

The covering physician must still be credentialed in the vast majority of cases, which means the Q6 modifier should not be used to bypass the credentialing process.

How Do You Use the Q6 Modifier Correctly?

To use the Q6 modifier correctly, append the Q6 modifier to the appropriate CPT or HCPCS code when submitting claims for the substitute physician’s services. The Q6 modifier should appear in box 24d after the procedure code. Ensure the claims are filed under the regular physician’s NPI, not the locum tenens provider.

Proper use of the Q6 modifier also involves the following elements: 

1. Ensure Compliance: Confirm that the substitute physician meets locum tenens criteria—primarily that they are contracted to cover for the regular physician temporarily and do not have an established patient base at the practice.
2. Time Limitations: Use the Q6 modifier only for services provided within a 60-day period from the start of the locum tenens arrangement.
3. Documentation: Maintain detailed records of the substitute physician’s services, including the dates and type of care provided.

Does Medicare Accept the Q6 Modifier?

Yes, Medicare accepts the Q6 modifier, but specific guidelines must be followed to ensure proper reimbursement. Medicare requires that:

• The locum tenens physician has a valid and unrestricted license in the state where the services are performed.
• The regular physician is unavailable due to temporary reasons, such as illness, leave, or continuing medical education.
• Services are billed within the 60-day period unless there is an exception, such as military service.

While Medicare recognizes the Q6 modifier, private payers may have different policies. It’s crucial to verify with each payer before submitting claims.

Get Help with Locums Billing

Managing locum tenens billing can be challenging, especially when navigating the nuances of modifiers like Q6. Era Locums specializes in locum tenens staffing and billing support, ensuring your practice stays compliant and maximizes reimbursement. Browse open positions or contact us today to start a new journey in locum tenens!

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