CMS Manual System

1 CMS Manual System Department of Health & Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 3774 Date: May 12, 2017 Change Request 10090 SUBJECT: Changes to the Payment Policies for reciprocal Billing Arrangements and Fee-For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements) I. SUMMARY OF CHANGES: The purpose of this CR is to 1. Implement section 16006 of the 21st Century Cures Act, which allows outpatient physical therapy services furnished by physical therapists in a health professional shortage area (HPSA), a medically underserved area (MUA), or in a rural area to be billed under reciprocal billing and fee-for-time compensation arrangements in the same manner as physicians bill effective no later than June 13, 2017.

2 The term locum tenens, which has historically been used in the Manual to mean fee-for-time compensation arrangements, is being discontinued because the title of section 16006 of the 21st Century Cures Act uses locum tenens arrangements to refer to both fee-for-time compensation arrangements and reciprocal billing arrangements. As a result, continuing to use the term locum tenens to refer solely to fee-for-time compensation arrangements is not consistent with the law and could be confusing to the public. 2. Update Pub. 100-04, chapter 1, sections ; ; ; ; and of CMS internet-only Manual (IOM) by changing Carriers to A/B MACs Part B and removing all references to UPIN (since the terms carriers and UPIN are obsolete). 3. Update sections and of the IOM to clarify that when a regular physician or physical therapist is called or ordered to active duty as a member of a reserve component of the Armed Forces for a continuous period of longer than 60 days, payment may be made to that regular physician or physical therapist for services furnished by a substitute under reciprocal billing arrangements or fee-for-time compensation arrangements throughout that entire period.

3 This policy is required by section 137 of the Medicare Improvements for Patients and Providers Act of 2008. EFFECTIVE DATE: June 13, 2017 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: June 13, 2017 Disclaimer for Manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN Manual INSTRUCTIONS: (N/A if Manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row. R/N/D CHAPTER / SECTION / SUBSECTION / TITLE R 1/TOC R 1/30 to Assignment of Provider s Right to Payment - Claims Submitted to A/B MACs Part B R 1/30 Under reciprocal Billing Arrangements - Claims Submitted to A/B MACs Part B R 1/30 Under Fee-For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements) - Claims Submitted to A/B MACs Part B R 1/30 Procedures for Entities Qualified to Receive Payment on Basis of Reassignment - for A/B MAC Part B Processed Claims R 1/30 Unacceptable Payment Arrangements III.

4 FUNDING: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. IV. ATTACHMENTS: Business Requirements Manual Instruction Attachment - Business Requirements Pub.

5 100-04 Transmittal: 3774 Date: May 12, 2017 Change Request: 10090 SUBJECT: Changes to the Payment Policies for reciprocal Billing Arrangements and Fee-For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements) EFFECTIVE DATE: June 13, 2017 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: June 13, 2017 I. GENERAL INFORMATION A. Background: The purpose of this CR is to 1. Implement section 16006 of the 21st Century Cures Act, which allows outpatient physical therapy services furnished by physical therapists in a health professional shortage area (HPSA), a medically underserved area (MUA), or in a rural area to be billed under reciprocal billing and fee-for-time compensation arrangements in the same manner as physicians bill effective no later than June 13, 2017.

6 The term locum tenens, which has historically been used in the Manual to mean fee-for-time compensation arrangements, is being discontinued because the title of section 16006 of the 21st Century Cures Act uses locum tenens arrangements to refer to both fee-for-time compensation arrangements and reciprocal billing arrangements. As a result, continuing to use the term locum tenens to refer solely to fee-for-time compensation arrangements is not consistent with the law and could be confusing to the public. 2. Update Pub. 100-04, chapter 1, sections ; ; ; ; and of CMS internet-only Manual (IOM) by changing Carriers to A/B MACs Part B and removing all references to UPIN (since the terms carriers and UPIN are obsolete). 3. Update sections and of the IOM to clarify that when a regular physician or physical therapist is called or ordered to active duty as a member of a reserve component of the Armed Forces for a continuous period of longer than 60 days, payment may be made to that regular physician or physical therapist for services furnished by a substitute under reciprocal billing arrangements or fee-for-time compensation arrangements throughout that entire period.

7 This policy is required by section 137 of the Medicare Improvements for Patients and Providers Act of 2008. B. Policy: Section 1842(b)(6)(D) of the Act allows payment to be made to a physician for physicians services (and services furnished incident to such services) furnished by a second physician to patients of the first physician if the first physician is unavailable to provide the services, and the services are furnished pursuant to an arrangement that is either (1) informal and reciprocal , or (2) involves per diem or other fee-for-time compensation for such services. In addition, the services must not be provided by the second physician over a continuous period of more than 60 days unless the regular physician or physical therapist is called or ordered to active duty as a member of a reserve component of the Armed Forces for a continuous period of longer than 60 days.

8 Effective June 13, 2017, this same process will be available to Medicare-enrolled physical therapists who use substitute physical therapists to furnish outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area. II. BUSINESS REQUIREMENTS TABLE "Shall" denotes a mandatory requirement, and "should" denotes an optional requirement. Number Requirement Responsibility A/B MAC DME MAC Shared- System Maintainers Other A B HHH FISS MCS VMS CWF Contractors shall implement the payment policies described in IOM Pub. 100-4, chapter 1, sections ; ; ; ; and X Contractors shall accept claims from Physical Therapists, Provider Specialty 65 Physical Therapist in Private Practice, for reciprocal billing arrangements, when submitted with the Q5 modifier.

9 X Contractors shall accept claims from Physical Therapists that are reported with a Q5 modifier whose descriptor references only physicians. When the descriptor is updated to include physical therapists and physicians, contractors shall accept the Q5 modifier with the updated descriptor. NOTE: The Modifier Q5 s descriptor will be amended to include physical therapists in addition to physicians in the near future in a HCPCS quarterly update. X Contractors shall suspend any editing that would cause physical therapist claims submitted with the Q5 modifier whose descriptor references only physicians to be denied or returned as unprocessable. X Contractors shall accept claims from Physical Therapists, Provider Specialty 65 Physical Therapist in Private Practice, for services provided by a substitute physical therapist under a fee-for-time compensation arrangement when submitted with the Q6 modifier.

10 X Contractors shall accept claims from Physical Therapists that are reported with the Q6 modifier whose descriptor references only physicians. When the descriptor is updated to include physical therapists and physicians, contractors shall accept the modifier with the updated descriptor. NOTE: Modifier Q6 s descriptor will be amended to include physical therapists in addition to physicians in the near future in a HCPCS quarterly update. X Contractors shall suspend any editing that would cause X Number Requirement Responsibility A/B MAC DME MAC Shared- System Maintainers Other A B HHH FISS MCS VMS CWF physical therapist claims submitted with the Q6 modifier whose descriptor references only physicians to be denied or returned as unprocessable. III. PROVIDER EDUCATION TABLE Number Requirement Responsibility A/B MAC DME MAC CEDI A B HHH MLN Article: A provider education article related to this instruction will be available at shortly after the CR is released.