Modifier GV

The attending physician is not employed or paid under agreement by the patient's Hospice provider.

Instructions

This modifier must be submitted when a service meets the following conditions, regardless of the type of provider:

  • Service was rendered to a patient enrolled in a Hospice.
  • Service was provided by a physician or non-physician practitioner identified as the patient's 'attending physician' at the time of that patient's enrollment in the Hospice program
  • Submit this modifier regardless of whether the services were related to the patient's terminal condition
  • Service was provided by a physician employed by the Hospice, you may not submit this modifier
  • Service was provided by a physician not employed by the Hospice and the physician was not identified by the beneficiary as his/her attending physician, you may not submit this modifier

Example

An independent attending physician or independent laboratory interprets the surgical pathology (88305) from a patient with a terminal illness related service. The professional component is billed to the Medicare contractor. If there is no professional component (e.g., clinical lab tests), then the Part A Hospice should only be billed.

Date of Service Treatment CPT/Modifier
01/14/12 Surgical pathology (professional component) Bill to Part B: 88305 26GV
01/14/12 Surgical pathology (technical component) Bill to Hospice: 88305 TC

 

Same rules apply for diagnostic tests

Date of Service Treatment CPT/Modifier
09/25/12 Chest x-ray (professional component) Bill to Part B: 71010 26GV
09/25/12 Chest x-ray (technical component) Bill to Hospice: 71010 TC

 

Resources

 

Last Updated Wed, 12 Feb 2020 16:11:28 +0000