OPTOMETRIC BILLING AND HOSPICE PATIENTS

YES! YOU CAN BILL AND BE PAID BY MEDICARE WHEN PERFROMING OPTOMETRIC/OPTOMETRIC BILLING SERVICES ON A HOSPICE ENROLLED PATIENT. READ THE ARTICLE BELOW TO FIND OUT HOW. AS ALWAYS, YOU MAY CONTACT opticXpress FOR HELP.


Part B Hospice Modifiers GV and GW
When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for
services that are related to the treatment and management of his terminal illness during the period his
hospice benefit election is in force, except for professional services of an “attending physician” who is
not an employee of the designated hospice and does not receive compensation from the hospice for
those services. Professional services of an “attending physician” are submitted with the GV modifier if
all conditions are met (description below). Any services provided to a patient enrolled in hospice that
are not related to the treatment and management of the patient’s terminal illness are submitted with
the GW modifier (description below).
For purposes of administering the hospice benefit provisions, an “attending physician” means an
individual who is a doctor of medicine, doctor of osteopathy or a nurse practitioner and is identified by
the individual at the time he elects hospice coverage as having the most significant role in the
determination and delivery of his medical care. The attending physician is not an employee of the
hospice and does not receive compensation from the hospice.
The following applicable modifiers should be used when billing for services of a patient enrolled in
hospice. The appropriate modifier usage will depend on who is providing the service, what services
are being provided and if the services are for/related to the reason the patient is enrolled in hospice.
GV Modifier
Attending physician not employed or paid under arrangement by the patient’s hospice
provider
This modifier should be used by the attending physician when the services are related to the patient’s
terminal condition and are not paid under arrangement by the patient’s hospice provider. Also, this
modifier must be submitted when a service meets the following conditions, regardless of the type of
provider:
 The service was rendered to a patient enrolled in a hospice.
 The 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.
Do not submit the GV modifier in the following conditions:
 The service was provided by a physician employed by the hospice.
 The service was provided by a physician not employed by the hospice and the physician was
not identified by the beneficiary as his attending physician.
GW Modifier
Service not related to the hospice terminal condition
This modifier should be used when a service is rendered to a patient enrolled in a hospice, and the
service is unrelated to the patient’s terminal condition. All providers must submit this modifier when
this condition applies or when claims are submitted for treatment for a non-terminal condition to the
Part A contractor with condition code 07. http://www.trailblazerhealth.com/Publications/Job%20Aid/HospiceModifiersGVGW.pdf