Q5 Modifier Definition
1 If services are provided by a substitute physician over a continuous period of longer than 60 days, the regular physician must bill the first 60 days with HCPCS modifier Q5 (services furnished by a substitute physician under a reciprocal billing arrangement). When a physician bills for a substitute physician, modifier Q5 or Q6 must follow the procedure code in Block 24D for services provided by the substitute physician. Also, a reciprocal billing physician may have more than one arrangement with other physicians with no required contract. Reciprocal billing claims require modifier Q5 in box 24D after the CPT/HCPCS code and the regular (absent) physician’s national provider id numbers are used for billing in 24J. The HCPCS modifiers Q5 and Q6 are designated for locum tenens usage and reciprocal billing arrangements. HCPCS Modifier Q6 - Payment Under Locum Tenens Arrangement. The usage of modifier Q6 was developed by CMS specifically to address billing concerns when a physician is away from their regular practice. Reciprocal billing claims require modifier Q5 in box 24D after the CPT/HCPCS code and the regular (absent) physician’s national provider id numbers are used for billing in 24J. For both locum tenens and reciprocal billing, modifiers Q5 and Q6 must be appended to each line of service. In the latter case the services are billed by the hospice to Medicare Part A.  If a substitute or locum tenens physician provides services, the designated attending physician bills the services using modifier GV and either the Q5 or Q6 modifier. The name and office or mailing address of the substitute physician must be documented on the claim in Block 19, not Block 33. When a physician bills for a substitute physician, modifier Q5 or Q6 must follow the procedure code in Block 24D for services provided by the substitute physician. If postoperative services are furnished by the substitute physician, the services cannot be submitted with HCPCS modifier Q5 since the regular physician is paid a global fee. Reference: 1  Submit HCPCS modifier Q5 to indicate that services were provided under a reciprocal billing arrangement.  If a substitute or locum tenens physician provides services, the designated attending physician bills the services using modifier GV and either the Q5 or Q6 modifier. Two modifiers that generate from the HCPCS Manual are modifiers Q5 and Q6 which are associated with locum tenens and reciprocal billing arrangements. These modifiers should be used if the coder has a complete understanding of the practice’s situation in terms of physician coverage.
Services furnished by a substitute physician under a reciprocal billing arrangement .