Hospice Modifiers, Modifier GV, Modifier GW

Hospice Modifiers (Modifier GV & Modifier GW)

The Hospice Modifiers (Modifier GV & Modifier GW) can be used when patients are enrolled in hospice and if they are expected to pass away within the next 6 months. A hospice modifier is required to indicate that a separate payment should be allowed when a patient in hospice is treated by a physician. The physician is not paid by the hospice or for a condition unrelated to the patient’s terminal condition. The care for the patient is expected to be given by the hospice care facility. Only care provided by a Medicare-certified hospice is covered under the hospice benefit provisions. Certain Medicare coverage does not apply to a beneficiary enrolled in a hospice program.

Hospice Modifiers GV & GW

Modifier GV & Modifier GW should be used when billing for services of a patient enrolled in hospice. The appropriate hospice modifier usage will depend on who is providing the service, what services are being provided and if the services are for/related to the reason the patient is enrolled in hospice.

GV Modifier

Description of Modifier GV: Attending physician not employed or paid under arrangement by the patient’s hospice provider.

Coding Guidelines For Modifier GV

The modifier GV should be used by the attending physician when the services are related to the patient’s terminal condition and are not paid under arrangement by the patient’s hospice provider. Also, modifier GV must be submitted when a service meets the following conditions, regardless of the type of provider:

  • The service was rendered to a patient enrolled in a hospice.
  • The service was provided by a physician or non-physician practitioner identified as the patient’s attending physician at the time of that patient’s enrolment in the hospice program.

Do not submit the GV modifier in the following conditions:

  • The service was provided by a physician employed by the hospice.
  • The service was provided by a physician not employed by the hospice and the physician was not identified by the beneficiary as his attending physician.

GW Modifier

Description of modifier GW: Service not related to the hospice terminal condition.

Coding Guidelines For Modifier GW

Modifier GW should be used when a service is rendered to a patient enrolled in a hospice, and the service is unrelated to the patient’s terminal condition. All providers must submit the GW modifier when this condition applies or when claims are submitted for treatment for a non-terminal condition to the Part A contractor with condition code 07. Ensure the correct diagnosis is submitted on the claim.

For example, if the patient’s terminal condition is pancreatic cancer and the primary diagnosis on the claim is cancer-related, this can be considered related and would cause the denial.

If modifier GW has been applied appropriately, it may be necessary to appeal the decision.

See also Medicare coverage for Hospice care

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *