The Centers for Medicare and Medicaid Services (CMS) have released numerous flexibilities to support providers during the public health emergency (PHE).

One waiver related to using substitute physicians (Locum Tenens) may have been overlooked recently as many were more focused on overcoming decreased volumes in this unprecedented pandemic.

As medical groups begin returning to a (new) normal heading into the summer months, we wanted to share background information on the adjustment to using Locum Tenens for the duration of the PHE.

Under a second round of blanket waivers issued in May, CMS adjusted the 60-day limit of using substitute physicians (Locum Tenens) during the COVID-19 public health emergency so that physicians could use the same substitute for the entirety of the PHE.  Physicians may also use the same substitute for additional time, no more than 60 continuous days, after the PHE expires.

Without this flexibility, a regular physician could only use a single substitute physician for a period no longer than 60 continuous days.  Anytime following the 60 days would require a different substitute or that the physician return to work for at least one day, which would reset the continuous time period.

On June 1, 2020, CMS released updated billing guidance for those utilizing this waiver flexibility.  This update clarified that, if a provider utilizes a substitute physician for longer than 60 continuous days, they must add the CR modifier to claims starting on the 61st day and beyond.  The CR modifier indicates to CMS that a provider is applying a blanket waiver issued due to a catastrophe or disaster.  CMS will not deny claims that include the CR modifier unnecessarily, but may deny claims that are missing the required modifier based on their new guidance.

The updated CMS guidance on which waivers/flexibilities require the CR modifier is available HERE.

Note: while this waiver removes the time limits of Locum Tenens, groups still must adhere to the standard rules for these arrangements which can be found HERE.

As always, ADVOCATE will continue to keep you informed on the issues impacting medical groups as they develop.


Kayley Jaquet

Manager, Regulatory Affairs