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Medicare Hospice Modifier GV and GW

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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

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is a 20 year veteran of healthcare having managed medical practices. He advises medical practices, physicians and practice administrators on how to run their practice and manage their medical billing and revenue cycle management. Manny speaks, blogs and makes videos at, a blog that is tops in the medical billing and coding field. READ MORE

4 Responses to Medicare Hospice Modifier GV and GW

  1. We did bill out to Medicare with GW modifier but Medicare has rejected it twice. The reason of the rejection is B15 : This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Any thought about this case Mr. Oliverez ?


    • The denial could be diagnosis driven as the GW modifier indicates that the “service is not related to the hospice patient’s terminal condition” – the very first thing I would look at would be the diagnoses. That could easily explain the denial. Another area to look at would be the CPT code being billed out and place of service location code.

      We did bill the GW modifier for some of our clients but also had some denials and we reverted to the GV modifier since that is the most applicable in our situation and the claims were paid.

      GV – Attending physician not employed or paid under agreement by the patient’s hospice provider.

      Another issue may be frequency – was the patient seen by another provider on the same date of service?

      Looking at the denial again I am leaning towards Medicare has either not qualified the patient as hospice or it is a CPT error.

      Just some thoughts.

  2. I have a doctor in the office that has a medicare provider number and is active, the other doctor is not – can that patient see the patient because the primary doctor is not available ?
    I did think so with a proper modifier

    • Well Yes and No.

      Yes the other doctor can see the patient but will have to bill under their own name. Make sure you use the limited charge. You can give the paperwork to the patient to submit a claim to Medicare for reimbursement.

      No there is no modifier. You may be thinking Incident-to but it does not apply in this case.

      For more info on how to bill for a non-participating provider check with your local Medicare carrier. There you will find specific instructions you must follow to remain in compliance.

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