What You Need to Know About Locum Tenens Physical Therapists and Medicare

It used to be that physical therapists could not rely on locum tenens contracts to provide care to patients covered by Medicare. If a physical therapist had to be absent for whatever reason, patients had to be referred to other local therapists able to temporarily pick up the slack. That is no longer the case.

Thanks to passage of the 21st Century Cures Act in December 2016, physical therapists now have full and complete access to the locum tenens option even for their Medicare patients. Passage of the law has certainly made life easier for physical therapists around the country.

  • A Brief History of the Law

The 21st Century Cures Act does a lot more than just open locum tenens contracts to physical therapists. But for the purposes of this discussion, the law’s locum physical therapist provision replaced a previously failed piece of legislation known as the Prevent Interruptions in Physical Therapy Act.

That legislation was introduced in the Senate in 2015 by Senators Charles Grassley (R-IA) and Bob Casey (D-PA). A companion bill was introduced in the House by representatives Gus Bilirakis (R-FL) and Ben Ray Lujan (D-NM). The intent of the legislation was to guarantee that physical therapists would “have the ability to ensure continuous care for their patients” via locum tenens.

Defeat of the legislation was a temporary setback for physical therapists. By including a provision in the 2016 law to do what the previous legislation could not, Congress has given physical therapists the same rights as other medical practitioners who seek reimbursement from Medicare.

How the Law Works

Federal law allows physical therapists who seek Medicare reimbursement to utilize locum tenens therapists on a short-term basis. As a general rule, this means covering for things like vacation time, maternity leave, disability, continuing education, etc.

For reimbursement purposes, Medicare is billed by the practice rather than the locum. The practice pays the locum directly under the conditions stipulated in their contract.

The law stipulates that certain conditions have to be met in order for a practice to bill Medicare for services provided by locums:

  • The practice physical therapist must be unavailable during that time the care was provided.
  • The patient must seek services during the time of unavailability.
  • The locum must be compensated on a per diem basis, or some similar fee-for-time model.
  • The physical therapist must not bill for locum-provided care for a period of time longer than 60 consecutive days.
  • The practice must use a modifier code to indicate that applicable billings relate to locum-provided care.

In the case of the 60-day time limit, it is not an annual limit. In other words, a physical therapist could bring in a locum for 60 consecutive days, return to work for a day, and then bring the locum back for an additional 60 days. Both 60-day periods are allowed.

Making Physical Therapy Better

Washington is to be commended for the work they have done to enhance continuity of care in physical therapy by passing the 21st Century Cures Act. Allowing physical therapists to utilize locum tenens contracts to provide continuous care makes physical therapy better for everyone involved.

Therapists can now take time away from the office with the knowledge that their Medicare patients will be treated in their offices rather than having to go elsewhere. They can take time away without having to worry about a loss of revenue. And for patients, the law makes it possible for them to continue receiving care in an office they are comfortable with, even if the practice therapist is a way temporarily.