What Is Modifier Q6 and When Should You Use It?

Understanding Medical Billing: Modifier Q6

Medical billing involves a complex system of codes and modifiers that convey specific details about healthcare services. Modifiers play an important role by providing additional information about a procedure or service, clarifying why it was performed in a particular way. Understanding these modifiers is essential for accurate claims processing and appropriate reimbursement within the healthcare system.

Understanding Modifier Q6

Modifier Q6 is specifically designed for use in medical claims when services are provided by a locum tenens physician. A “locum tenens physician” refers to a substitute physician who temporarily takes the place of another physician. This modifier allows the practice to bill for services rendered by the substitute physician under the absent physician’s National Provider Identifier (NPI).

The primary purpose of Modifier Q6 is to ensure continuity of patient care and maintain a consistent billing process during the regular physician’s absence. By utilizing this modifier, the services provided by the temporary physician can be processed as if they were delivered by the usual provider. This arrangement prevents disruptions in patient care and avoids the need for the substitute physician to undergo a full credentialing process with every payer for short-term assignments.

Conditions for Using Modifier Q6

The appropriate use of Modifier Q6 is subject to specific rules and circumstances. A primary condition is that the regular physician must be temporarily absent from their practice. This modifier is not intended for situations where a practice is expanding or permanently filling a vacancy.

A common duration limit for locum tenens arrangements, particularly for Medicare claims, is 60 continuous days. This 60-day period begins on the first day the locum tenens physician provides services to a Medicare patient. An exception to this rule applies if the regular physician is called to active duty in the armed forces, in which case the substitute physician may provide services for a longer, even unlimited, duration.

The locum tenens physician must also be legally qualified and licensed to practice medicine in the state where services are rendered. They are typically required to hold a medical degree, have completed residency training, and possess an active, unrestricted medical license. While often preferred, board certification or eligibility is also a common requirement for these temporary roles. Individual payers may have their own distinct requirements or limitations for the application of Modifier Q6.

Billing and Documentation Requirements

When utilizing Modifier Q6, it is appended to the appropriate Current Procedural Technology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code for the service provided. On the standard CMS-1500 claim form, this modifier is typically placed in Box 24D, immediately following the procedure code. This precise placement ensures that the payer recognizes the temporary substitute arrangement for the billed service.

Accurate documentation is essential for claims submitted with Modifier Q6. The patient’s medical record should clearly indicate that the service was performed by a locum tenens physician, including their full name. Additionally, the regular physician is generally responsible for keeping a record of each service provided by the substitute, along with the locum tenens physician’s National Provider Identifier (NPI), which must be available upon request. Adhering to these specific billing and documentation requirements is important for avoiding claim denials, potential audits, and maintaining compliance.