When one of your permanent providers takes leave, whether for health reasons or a well-deserved vacation, healthcare organizations often face two challenges: maintaining patient care and protecting revenue. That is where the Q6 modifier comes in.
What is the Q6 modifier?
The Q6 modifier, sometimes referred to as the locum tenens modifier, is a procedural billing code that can be used to indicate that a locum tenens provider is substituting for an absent, enrolled provider. It can allow your organization to bill under the absent provider’s National Provider Identifier (NPI) for up to 60 consecutive days without enrolling the locums provider with every insurance payor.
This can be especially useful when credentialing timelines don’t align with your urgent coverage needs. The Q6 modifier is accepted by Medicare and Medicaid nationwide, however private payor acceptance varies and should be verified contract by contract.
How the Q6 modifier works.
1. Confirm eligibility: Confirm that the provider is temporarily absent and a locum tenens of the similar title and specialty is substituting for them.
2. Add Q6 modifier to the claim: Add Q6 after the procedure code on the billing form.
3. Use the permanent provider’s NPI: Use the NPI of the absent provider, not the locums provider
Understanding how to apply the Q6 modifier correctly is important for maintaining compliance and protecting your facility’s revenue during a provider’s absence. While billing for a locum under the absent provider’s NPI is a simple concept, the execution requires high attention to detail. Consult with your legal or compliance team given the variations that may exist based on the payor involved.
Confirm eligibility.
The Q6 modifier is only valid when a locum tenens provider is covering an absent, enrolled provider of the same title and similar specialty. For example, one orthopedic surgeon can cover for a podiatrist, but a general surgeon cannot cover for a podiatrist. The absence must only be temporary, not due to the permanent provider’s resignation or death.
Add the Q6 modifier to the claim.
On the billing form, the Q6 modifier is added after the procedure code in the designated modifier field. This will tell the payor that the care given was performed by a substitute provider, but the care that was given remains unchanged.
Use the absent permanent provider's NPI.
The submitted claim must include the NPI of the absent provider, not the locum tenens NPI. This is what allows the claim to be processed without the locums provider being enrolled in the payor’s system. However, the absent provider must not submit any claims on the same day, or it could trigger a red flag for duplicate billing.
Strategic applications.
The Q6 modifier is not just a tool for billing. It is a strategic asset that can help your organization stay agile, protect its revenue, and maintain healthy access to care during an absence. Here is how you can think beyond the basics and use the Q6 modifier as part of a broader staffing strategy:
Reset the 60-day clock.
One of the most powerful ways the Q6 modifier is utilized is through resetting the clock. If the permanent provider returns and bills, even for just one day, the 60-day window may restart. This allows your organization to extend locums coverage over longer periods without risking noncompliance. This should never be the plan but if a situation arises where you need to extend coverage, this could be a way to keep the locum tenens on board.
Temporary coverage during the licensing process.
Licensing can often delay coverage for weeks or more. The Q6 modifier lets you start billing quicker under the absent provider’s NPI while the licensing process for a different long-term locum tenens or new permanent provider is being completed. This is a smart way to avoid revenue loss while you prepare for long-term coverage.
Prevent revenue loss during care gaps.
Even a brief absence could lead to significant revenue loss. The Q6 modifier lets you keep your facilities fully staffed and patients on the schedule, so you can rest assured that revenue is safeguarded.
Medicare + Medicaid vs. private payors.
One of the perks of the Q6 modifier is that it is universally accepted by Medicare and Medicaid when used for a true locum tenens need. This makes it a reliable option if your practice relies heavily on government payors.
However, private payors are not as straightforward. Each private insurance company has its own policies around the acceptance of the Q6 modifier. Some may allow it under specific contract terms, while others may not recognize it at all.
A best practice is to always review your private payor contracts for keywords like “substitute provider”, “locum billing,” or “Q6 modifier.” If the terms are unclear, you may need to contact the payor directly for further clarification. A proactive review of your payor agreements can prevent denials and help you stay in compliance.
Empower your billing team.
The Q6 modifier is only effective if your team knows how to use it properly. Discuss its use with your billing/coding experts or legal department. Take the time to provide comprehensive training for your billing staff on all aspects of the Q6 modifier, including when to apply it, correct NPI usage, and understanding the unique requirements of different payors. Emphasize the importance of attention to detail and keeping up to date with evolving compliance guidelines. With a well-informed team, your organization can confidently navigate provider absences, reduce the risk of billing errors, and ensure seamless reimbursement during times of transition.
Don’t navigate the Q6 modifier alone.
The Q6 modifier can be a powerful tool when it is used correctly, but we know it is not always a simple process. Every payor contract, provider scenario, and staffing need is different. That is why Jackson and Coker is here to help you learn the right questions to ask and explore your options.
Whether you are facing an unexpected provider absence or just want to plan ahead for future gaps, our team is ready to support you with insights, resources, and real-world experience. If you are not sure if the Q6 modifier is right for your organization, let’s talk through it together.
