A reciprocal billing arrangement is when there is an agreement between physicians to cover each others practice.
A physician or his practice may set up reciprocal billing arrangements with one or more physicians to cover another practice or their own practice. There is certain criteria that must be met to receive Physician Payment under Reciprocal Billing Arrangements.
- The regular physician is unavailable to provide the services;
- The Beneficiary has arranged or seeks to receive the services form the regular physician
- The substitute physician does not provide the services to the beneficiary over a continuous period longer that 60 days and
- The regular physician submits the claim with HCPCS modifier Q5 (service furnished by a substitute physician under a reciprocal billing arrangement)
Billing for services:
The regular physician bills the visit under his/her NPI using the appropriate HCPCS modifier, in this case Q5. The reimbursement will be paid to the regular physician, not the substitute physician.
Reciprocal Billing Arrangements – Use Q5 Modifier
Locum Tenens now called "Payment Under Fee-For-Time Compensation" Arrangements – Use Q6 Modifier
