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Basics of Modifier GV and Modifier GW

Hospice is a specialized type of care for those facing a life-limiting illness, their families and their caregivers. Hospice care addresses the patient’s physical, emotional, social and spiritual needs. Hospice care also helps the patient’s family caregivers. There are few modifiers which are to be used only when the patient is enrolled in a Medicare certified Hospice. These modifiers play an important role in the payment process or medical billing/claims. Use of modifier GV or GW is only for the hospice patients.

Difference between GV and GW modifier

Their is very small difference in assigning the GV and GW modifiers for hospice patient. Here, the modifier is reported when the physician provides a service like which is related or unrelated to the diagnosis for which the patient was enrolled into hospice. The physician has nothing to with hospice, he or she is only responsible for providing services as attending physician.

When the physician provide a service related to the hospice diagnosis for which the patient is enrolled, GV modifier is used.

When the physician provides a service unrelated or not related to the hospice diagnosis for which the patient is enrolled , GW modifier is used.

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

GW – Service not related to the hospice terminal condition

Attending Physician|| GV vs GW modifier

Only the direct professional services of an independent attending physician, who may be a nurse practitioner, may be submitted. The costs for services such as lab or X-rays are not to be included on the claim.

When the attending physician or nurse practitioner furnishes a terminal illness-related service that includes both a professional and technical component (e.g., X-rays), he or she submits the professional component of such services to the carrier and looks to the hospice for payment for the technical component
Likewise, he or she would look to the hospice for payment for terminal illness related services furnished that have no professional component (e.g., clinical lab tests)

When to append Hospice Modifier GV

GV modifier indicates that the attending physician is 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 or not paid under arrangement by the patient’s hospice provider. Claims from the attending physician for services provided to hospice-enrolled patients may be submitted to Palmetto GBA with Healthcare Common Procedure Coding System (HCPCS) modifier GV. This is true regardless of whether the care is related to the patient’s terminal illness. HCPCS modifier GV signifies that:

The service was rendered to a patient enrolled in a hospice
The service was provided by a physician or nonphysician practitioner identified as the patient’s attending physician at the time of that patient’s enrollment in the hospice program
If the service was provided by a physician employed by the hospice, HCPCS modifier GV may not be submitted
If the service was provided by a physician not employed by the hospice and the physician was not identified by the beneficiary as his or her attending physician, HCPCS modifier GV may not be submitted

When to append Hospice Modifier GW

The GW modifier indicates that the service rendered 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 non-terminal conditions under Medicare Part A. Effective on or after January 5, 2019, any services submitted without the GV modifier under the conditions outlined above will be denied.

Do not append GV modifier when the service was provided by a physician employed by the hospice and when 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.

Modifier GW is used when a provider of services (physician, ambulance supplier, etc.) performs services not related to the hospice diagnosis. Certain Medicare beneficiaries can choose hospice benefits instead of Medicare for treatment and management of their terminal condition.

If a substitute or fee-for-time compensation arrangements physician provides services, the designated attending physician bills the services using modifier GV and either the Q5 or the Q6 modifier.

Medicare considers a physician volunteer with the hospice to be an employee.

When to use HCPCS code G0337

Payment to the hospice agency for the provision of this evaluation and counseling service is made using
HCPCS code G0337

Code G0337 will be paid only when billed by the hospice agency to its Medicare intermediary. Claim line items with G0337 submitted to a Medicare carrier will be denied. The hospice should submit such claims to its intermediary using type of bill 81x or 82x with the G0337 code and a revenue code of 0657 as the only revenue code on the claim.

Use of Q5 and A6 modifier

If a substitute or locum tenens physician provides services, the designated attending physician bills the services using modifier GV and either the Q5 or the Q6 modifier.