Medicare Hospice Modifiers GV and GW

Medicare:
How to use GV and GW Modifiers

We 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

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