Patient Enrolled in Hospice

Common Reasons for Message

  • Patient is enrolled in Hospice on date of service
    • Medicare Part B only pays for physician services notrelated to Hospice condition and not paid under arrangement with Hospice entity
  • Patient's Common Working File (CWF) has not been updated to show Hospice election has been revoked

Next Step

  • Append Hospice modifier if appropriate
    • Modifier GV - Attending physician is not employed or paid under agreement by patient's Hospice provider
    • Modifier GW - Condition not related to patient's terminal condition
  • Submit Appeal request - Items or services with this message have appeal rights
    • See Appeals webpage for instructions on how to submit a Reopening or Redetermination 

Claim Submission Tips

View reason code list, return to Reason Code Guidance page.

 

Last Updated May 11, 2018