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Medicare Hospice Modifier GV and GW

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Medicare:
How to use Modifier GV and Modifier GW

Medicare modifier GV and modifier GWWe do medical billing for physician offices that do Care Plan Oversight (CPO) for Hospice Patients.  When billing for those services, G0182, we use the following Medicare modifiers:

GV Modifier

The GV modifier is used when a physician is providing a service that is related to the diagnosis for which a patient has been enrolled into hospice. This physician is not associated with the hospice and is providing services as a private physician.

GW Modifier

The GW modifier is used when a physician is providing a service that is not
related to the diagnosis for which a patient has been enrolled into hospice. This physician is not associated with the hospice and is providing services as a private physician.

When a patient is under hospice there is a certain diagnosis that was indicated at the beginning of care. If the service the physician renders is unrelated to the terminal illnesses that hospice has on record, Medicare will not reimburse for the service unless it is submitted with the modifier GW.  The GW modifier cuts through the Medicare edits and will pay.

For more information on properly billing GV and GW modifiers see CMS Pub 100-4, Chap 11 Section 40.2
Medicare Billing Services

2 Responses to “Medicare Hospice Modifier GV and GW”

  1. […] Medicare Hospice Modifiers GV and GW : Medical Billing Company …When billing for Medicare Care Plan Oversight(CPO) Hospice Services, G0182, use Modifier GV and Modifier GW. […]

  2. Hospice billing | Kemchoamerica says:

    […] Medicare Hospice Modifiers GV and GW – Capture BillingWhen billing for Medicare Care Plan Oversight(CPO) Hospice Services, G0182, use Modifier GV and Modifier GW. […]

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The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly.

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