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36.3.2 Substitute Physician
Physicians may bill for the service of a substitute physician who sees clients in the billing physician's practice under either an informal arrangement of less than 14 days or a formal renewable arrangement of up to 90 days.
The substitute physician is not required to enroll in the Texas Medicaid Program. The billing provider's name, address, and national provider identifier must appear in Block 33 of the claim form. The substitute physician's name and address must be documented on the claim in Block 19, not Block 33.
When a physician bills for a substitute physician, the modifier Q5 or Q6 must follow the procedure code in Block 24D for services provided by the substitute physician. The Q5 modifier is used to indicate an informal reciprocal arrangement (period not to exceed 14 continuous days) and the Q6 modifier is used to indicate a formal renewable locum tenens or temporary arrangement (up to 90 days).
When physicians in a group practice bill substitute physician services, the performing provider identifier of the physician for whom the substitute provided services must be in Block 24J.
Physicians must familiarize themselves with these requirements and document accordingly. Those services not supported by the required documentation as detailed above will be subject to recoupment.
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