Section 16006 of the 21st Century Cures Act contains a provision that extends mutual billing to physiotherapists providing physiotherapy services in a medically underserved area (MUA) or rural area, as defined in Chapter 1 of the Medicare Claims Processing Manual, Section 30.2.10. This amendment entered into force on 13 June 2017. Payment under Reciprocal Billing Agreements Pursuant to Section 16006 of the 21st Century Cures Act, a medicare physiotherapist may use a replacement physiotherapist on or after June 13, 2017 to provide outpatient physiotherapy services in an HPSA, MUA or rural area, under a mutual settlement agreement. A physician or physiotherapist may have reciprocal billing agreements with more than one physician or physiotherapist. Agreements do not need a written form. Where the only services provided by a doctor in the context of an operation are postoperative services provided during the period covered by the global fee, those services need not be declared as services of a substitute doctor on request. A physician or physiotherapist may have reciprocal billing agreements with more than one physician or physiotherapist. Agreements do not need a written form. A “continuous period of covered visiting services” begins on the first day the surrogate physician or Medicare physiotherapist provides visiting services provided by the regular physician or physiotherapist, and ends with the last day the surrogate physician or physiotherapist cares for these patients before the regular physician or physiotherapist returns to work. This period continues without interruption on days when no insured visits are provided to patients on behalf of a regular physician or physiotherapist, or by another surrogate physician or physiotherapist on behalf of the regular physician or physiotherapist. A new period of covered visiting services may begin after the regular doctor or physiotherapist has returned to work.
By entering the Q5 modifier in a claim position, the physician or regular physiotherapist (or, where applicable, the medical or physiotherapy group) certifies that the services are covered for the visits of the surrogate physician or physiotherapist indicated in a data set available for consultation with the doctor or physiotherapist. and are services for which the doctor or regular physiotherapist (or group) has the right to assert the right . . .