Coding guidelines for part b hospice GV and GW

When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for services that are related to the treatment and management of his terminal illness during the period his hospice benefit election is in force, except for professional services of an “attending physician” who is not an employee of the designated hospice and does not receive compensation from the hospice for those services. Professional services of an “attending physician” are submitted with the GV modifier if all conditions are met (description below). Any services provided to a patient enrolled in hospice that are not related to the treatment and management of the patient’s terminal illness are submitted with the GW modifier (description below).

For purposes of administering the hospice benefit provisions an “attending physician” is defined as follows (must meet all requirements):

An individual who is a doctor of medicine, doctor of osteopathy or a nurse practitioner.
Is identified by the beneficiary as having the most significant role in the determination and delivery of his medical care at the time hospice coverage is elected.
Is not an employee of the hospice and does not receive compensation from the hospice.
The following applicable modifiers must be used when billing for services of a patient enrolled in hospice. The appropriate 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

Attending physician not employed or paid under arrangement by the patient’s hospice provider

This modifier 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, this modifier 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 enrollment 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

Service not related to the hospice terminal condition

This modifier 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 this modifier when:

The service(s) provided are unrelated to the patient’s terminal condition.

Claims are submitted for treatment of a non-terminal condition to the Part A MAC with condition code 07.

The following charts should be used to determine when the services of a hospice patient should be covered and when to report the appropriate modifiers.