Modifier Coding Alert

Question: I’ve always just used one or the other of modifiers GV and GW even though we are not paid by hospice. Can they be used at the same time if the service is not related to hospice?

Maine Subscriber

Answer: No, you can’t use modifiers GV (Attending physician not employed or paid under arrangement by the patient’s hospice provider) or GW (Service not related to the hospice patient’s terminal condition) together. They have distinct differences. 

Using modifier GW means your physician isn’t treating the patient’s cancer or other condition that caused them to be in hospice. GV means the physician is seeing the patient for something related, but is not part of the hospice organization and is not being reimbursed under the Medicare Part A benefit.

Example: A beneficiary is enrolled in hospice and goes to a physician’s office for closed treatment of a metatarsal fracture (28470, Closed treatment of metatarsal fracture; without manipulation, each). 

When the procedure is not related to the terminal diagnosis the physician should bill with modifier GW.

Modifier GV means the service is related to the hospice beneficiary’s terminal condition and your kis not getting Part A hospice money because you are a Part B provider. 

Example: A patient is on hospice starting August 1, 2013 through August 31, 2013. Your physician bills 45378 (Colonoscopy, …)

CPT® code 45378 would be incorrect since the beneficiary was in hospice and there can be no separate reimbursement unless the service was unrelated to the terminal diagnosis or the attending physician was otherwise entitled to separate reimbursement, which would be reflected by the use of modifier GV or GW.