Modifier Q5- Service Furnished Under a Reciprocal Billing Arrangement

Modifier Q5 is used when a physician provides services for another physician under a reciprocal billing arrangement.

What is Modifier Q5?

Modifier Q5 tells insurance payers that a substitute physician furnished services for another physician under a reciprocal billing arrangement.

When to Use Modifier Q5

• A substitute physician provides patient care
• A reciprocal billing arrangement exists
• The regular physician is temporarily unavailable
• Medicare billing requirements are met

Billing Example

A physician is away for a short period, and another physician treats the practice's patients under a reciprocal billing arrangement. Modifier Q5 may be appended to eligible claims.

Documentation Tips

• Document the reciprocal billing arrangement
• Record the dates services were provided
• Verify Medicare billing requirements
• Maintain complete patient records

Common Denial Reasons

• Reciprocal billing requirements not met
• Missing documentation
• Incorrect modifier usage
• Billing exceeds Medicare limitations

Related Modifiers

Modifier GX

Modifier GA

Modifier Q6