How to bill for locum tenens services

Are you consistently billing your payors for services performed by locum tenens at your practice or healthcare facility? If not, you're likely leaving money on the table. Whether your facility needs a short-term physician replacement or longer-term supplemental physician services, it’s important to capture every available revenue dollar for the services rendered by locum tenens physicians.

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Where do I start?

The first step in billing for locum tenens services is to identify the type of temporary physician services you need: replacement or supplemental.

• Replacement is the classification for a locum tenens physician who will be filling in for your regular physician when he or she is unavailable. They provide services for a short period of time, typically 60 days or fewer.

• Supplemental services are used when you are looking to grow your practice and need the services of a physician in addition to your current staff, or if you need to replace a provider for more than 60 days.

Once you have determined this, follow the recommended guidelines for billing for the type of services needed.

Watch the following video to learn more about each of these types of services, including:

• When to use Medicare code modifier Q6

• When to begin standard payor enrollment

Private payors, Medicaid, and Medicare

Many private payors and state Medicaid programs follow Medicare guidelines, but it’s good practice to verify each program independently. Although it may not make sense to enroll every locum tenens provider with every payor you work with, you will usually want to enroll them with three to five of your largest payors. This will allow you to bill for a majority of the services they provide for patients. You’ll need to know the following about your patient population:

• What is the payor breakdown?
  – % of Medicare/Medicaid patients
  – % of private payor patients

• Who are the main insurance carriers?

Here’s a simple infographic that can help you determine when it makes sense to pursue payor enrollment.

Billing for supplemental physician services

Section 30.2.7 of the Medicare manual chapter 1 covers billing for supplemental physician services. It allows a carrier to make payments to your group for services performed by a supplemental physician who has a contractual agreement to see your patients.

Important considerations:

1. The organization receiving payment and the person who provided the service are jointly responsible for any Medicare overpayment.

2. The person who provided the service has unrestricted access to claims submitted for services.

   • When using services performed under a contractual arrangement, the supplemental provider will complete the necessary applications to bill for services with each of your private carriers and the Medicaid program for your state.

   • Additionally, the provider will complete Medicare’s Form 855i to enroll the provider and allow your practice to bill Medicare for their services.

   • A provider may have billing rights assigned to multiple practices or groups, and the same form is used to rescind billing privileges once an assignment is completed.

Billing for replacement physician services

Section 30.2.11 of the Medicare manual chapter 1 covers billing for replacement services. It allows a practice to bill for temporary physician services during the absence of a regular physician who normally would have been scheduled to see a patient.

For this type of reimbursement to take place, the organization arranges coverage for the regular physician for no longer than 60 continuous days and then enters HCPCS code modifier Q6 after the procedure code during the billing process.

In addition:

• There is an exception for active military duty; if a physician is deployed for longer than 60 days, payment may be made for replacement services for that physician for the entire period.

With a little planning and effort, good locum tenens billing practices can help you turn locums from a cost center into a profit center.

How much revenue can I generate? Use this calculator to find out.

Where to get more information on how to bill for locum providers

If you are new to billing for locum tenens services, you may want to review one of the following guides. They cover both basic billing processes and provide details on billing for supplemental and replacement services using the Q6 modifier and Form 855i:

• How Medical Billing Works in 2025: A Step-By-Step Guide (The Medical Practice)

• When and How to Bill Using the Locums Q6 & Q5 Modifier (Physician Practice Specialists)

• Bill Locum Tenens Per CMS Guidelines (AAPC Knowledge Center)

• What are CPT Modifiers 22, KX, Q5, and Q6? A Guide for Medical Coders (Med. Report)

Pitfalls to avoid when billing for locum tenens services

It’s more important than ever to make sure you are billing correctly for locum tenens services. In a 2024 survey, 73% of providers said claim denial rates are increasing, compared to just 42% in 2022.

Here are the top five mistakes to avoid when billing for supplemental or replacement physician services.

1. Using locum tenens modifiers during credentialing

Before a new provider is credentialed, government payors like Medicare and Medicaid generally consider billing under a locum tenens modifier as non-compliant with few exceptions. So, make sure your locum providers are fully credentialed before submitting claims for services provided.

2. Misuse of replacement services

A Q6 modifier can only be used when a regular physician is away for vacation, illness, or other short-term absence. It cannot be used for other purposes, such as covering uncredentialed new providers.

3. Exceeding the 60-day limit

Billing for replacement services is limited to 60 continuous calendar days. The period does not pause and restart if a locum physician is not seeing patients every day during that period. If a locum provider will be covering for more than 60 days, they should billed as supplemental services.

4. Errors in locums claims submissions

Claims made using the CMS 1500 form must include the Q6 modifier in box 24d and list the regular physician’s NPI number in box 24j.  Failure to include both can cause your claims to be denied.

5. Misuse of Q5 modifier

Be careful to use the correct Q6 modifier for locums, and not the similar Q5. The latter is for reciprocal billing within the same group and not for temporary services provided by a locum tenens provider.

Streamline your process: How to improve provider credentialing

Improve claim reimbursement rates with technology

The top reason for claim denials is missing or inaccurate data. According to Experian Health, 72% of healthcare organizations are turning to technology solutions to improve claims processing.

Some of the top solutions for improving payor enrollment rates and claims processing for locum tenens providers include:

• Locum tenens vendor management systems such as Locumsmart and HWL Works

• Claims automation platforms like Change Healthcare and WNS

• Provider credentialing and enrollment services such as Modio Health and symplr

Where to get help

If you need assistance determining the best way to bill for replacement or supplemental locum tenens services for your organization, call us at 800.453.3030.