Tuesday, July 23, 2013

Modifiers for Special Situations in Hospice

Special modifiers should be used for the following circumstances [MCM 4175.1, 4175.2]:

**  If another physician covers for the designated attending physician, the services of the substituting
physician are billed by the designated attending physician under the reciprocal or locum tenens
billing instructions [MCM 3060.6, 3060.7 see Locum tenens, reciprocal billing chapter]. In such
instances, the attending physician bills using the GV modifier and either the Q5 or Q6 modifier. 

**  Medically necessary Part B services that physicians furnish to patients after their hospice benefits
are exhausted or revoked should be billed without the GV or GW modifiers. 

** Services unrelated to a hospice patients terminal condition should be coded with the GW modifier
“service not related to the hospice patient’s terminal condition.” 

Don’t Bill DME, Supplies or Therapy for Terminal Condition

DME,  supplies,  and  independent  speech  and  physical  therapy  claims  related  to  the  hospice  patient’s  terminal condition are not payable by Part B. The hospice is required to bill and be paid for such services through its intermediary


  1. Hi. You can find a blank Fillable CMS 1500 Insurance Claim Form here.

    Please feel free to use it. You can fill out the form, save it, fax it, and email it.

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