Modifiers GV and GW

Modifiers GV and GW are HCPCS Level II Medicare Hospice Modifiers.

What is Hospice?

It is a place where palliative and supportive care provided for terminally ill patients.

Hospice healthcare services performed by the patients attending physician who is employed/ paid/ part of hospice should be submitted to hospice contractor for reimbursement.

However, if the attending physician who is not employed or part of hospice performs the hospice services (related/not related to the patient was admitted into hospice), then those claims will be submitted to Medicare by provider along with GV or GW modifier to indicate that a separate payment should be allowed.

Now let us see when to use GV and GW Modifiers appropriately to Medicare.

Modifier GV

Append GV modifier when the patient diagnosis is related to hospice diagnosis and the attending physician who perform the services is not employed or paid by hospice.

It means when patient was admitted into hospice and the patients attending physician who is not employed/not paid/not part of hospice provider, performs the services related to the problem for which a patient was admitted, then provider must append GV modifier to the procedure code when submitting those services to Medicare for reimbursement.

Guidelines:

  • Do not append GV modifier, when attending physician is employed by the hospice provider. Since those claims will be submitted to Hospice contractor for reimbursement.
  • Do not append GV modifier, when physician who perform the services was not employed by the hospice provider and was not identified by the patient as his/her attending physician.
  • Append GV modifier when the beneficiary enrolled in hospice program and the attending physician who is not employed by the hospice, performs the services related to patient’s terminal condition.

Example:

Assume a patient enrolled in hospice for congestive heart failure and goes to the attending physician, who is not associated with hospice entity for the services which is related to congestive heart failure.

In the above case the procedure performed by the attending physician is not associated with hospice and the services performed by the attending physician are related to the congestive heart failure. Hence those procedure codes to be reported with GV modifier.

 

GW Modifier

Append GW modifier when the patient diagnosis is not related to hospice diagnosis and the attending physician who perform the services is not employed or paid by hospice.

It means when patient was admitted into hospice and the patients attending physician who is not employed/not paid/not part of hospice provider, performs the services which is not related to the problem for which a patient was admitted, then provider must append GW modifier to the CPT code when submitting those services to Medicare.

Guidelines:

Do not append GW modifier to CPT, when attending physician is employed by the hospice provider. Since those claims will be submitted to Hospice contractor for reimbursement.

Do not append GW modifier, when physician who perform the services was not employed by the hospice provider and was not identified by the patient as his attending physician.

Append GW modifier only when the beneficiary enrolled in hospice program and the attending physician who is not employed by the hospice, performs the services which is not related to patient’s terminal condition.

Example:

A patient was enrolled in hospice for congestive heart failure and goes to the attending physician who is not associated with hospice entity for a debridement of nail.

In the above case the procedure performed is unrelated and the attending physician is not associated with hospice. Hence provider should append GW modifier for the CPT 11720(Debridement of Nail).

11720 GW.

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