Locum Tenens

Key facts

Meaning

Latin for "holding the place"

Medicare substitute billing

Section 1842(b)(6)(D) of the Social Security Act

Medicare claim modifiers

Q5 (reciprocal billing) and Q6 (fee-for-time compensation)

Medicare time limit

Generally 60 continuous days, with exceptions such as military duty

What is locum tenens?

Hospitals, practices and health systems use locum tenens clinicians to cover vacations, parental leave, illness, open positions during recruitment and seasonal demand. Physicians, nurse practitioners, physician assistants and certified registered nurse anesthetists all take locum assignments, and anesthesiology, emergency medicine, hospital medicine, psychiatry and radiology are common locum specialties.

Locum clinicians are usually independent contractors rather than employees. They still need a license in the state where they work, credentialing and privileges at each facility, and malpractice coverage, which staffing agencies often arrange.

How Medicare billing works for substitute physicians

Medicare normally pays only the clinician who performed a service, but federal law allows two substitute arrangements:

• Reciprocal billing: a physician covers for an absent colleague on an occasional, reciprocal basis, and the absent physician bills for the services with modifier Q5.
• Fee-for-time compensation: the absent physician pays a substitute on a per diem or similar basis and bills with modifier Q6. CMS formerly called this a locum tenens arrangement.
• Limits: the regular physician must be unavailable, and a substitute generally cannot provide services for more than 60 continuous days, with exceptions such as a physician called to active military duty.

Why locum tenens matters

Locum use is a signal of workforce strain. Heavy reliance in a specialty or region points to recruitment problems, and many rural hospitals depend on locum coverage to keep services open. Physician recruiters, staffing firms and health system workforce planners track this demand.

Locum work also distorts provider data. Services billed with Q5 or Q6 are credited to the absent physician's NPI, and locum clinicians can list many short-term practice locations, so claims and directory data may misstate who treated patients and where a clinician is based.