GV and GW Modifiers for Hospice Claims- Explained

GV is used when the hospice patient’s attending physician named on the election, who is not employed by the hospice or paid under arrangement, bills for care related to the terminal condition. GW is used when the service or item is unrelated to the patient’s terminal condition while the patient is in hospice.

Do this: Ask two questions. Are you the named attending, and is the service related to the terminal condition? If yes to both, add GV. If unrelated, add GW. For facility claims, use Condition Code 07.

What Is A GV Modifier?

GV tells the payor that the billing doctor is the hospice patient’s attending physician, the care is related to the terminal illness, and the doctor is not employed by the hospice or paid under arrangement. Add GV on the service line of the CMS 1500 in Box 24D. If a covering physician sees the patient on behalf of the attending, use Q5 or Q6 with GV. Do not use GV on UB 04 facility claims, and do not use it for unrelated services.

What Is A GW Modifier?

GW tells the payor that a service or item is not related to the hospice patient’s terminal illness. Use it while the patient is in hospice so the line is paid outside the hospice bundle. Add GW on each unrelated service line on the CMS 1500 in Box 24D. For facility claims, do not add GW on the line. Use Condition Code 07 on the UB 04 to show the service is unrelated.

Difference between GV and GW

GV is about related care by the attending physician who is not employed by the hospice. GW is about unrelated care during a hospice episode, no matter who provides it. To choose fast, ask two questions. Are you the attending named on the hospice election, and is the service related to the terminal illness? If yes to both, use GV. If the service is not related, use GW. For facility claims that are unrelated, use Condition Code 07 instead of GW.

Where to put GV or GW on the claim?

On professional claims, add the modifier at the line level in Box 24D of the CMS 1500. Use GV when the attending physician named on the hospice election bills for care related to the terminal illness and is not employed by the hospice. Use GW when the service or item is not related to the terminal illness while the patient is in hospice. Example line entry looks like 99213 GV for a related visit by the attending, or 73610 GW for an unrelated X-ray.

If a line needs more than one modifier, put payment modifiers first, then any coverage or informational modifiers. When a covering physician treats the patient, place Q5 or Q6 before GV on that line. For example, 99213 Q6 GV shows a locum tenens visit for related care billed on behalf of the attending.

On facility claims, do not use GW on UB 04 lines. Show unrelated services with Condition Code 07 in the condition code area of the UB 04. This tells the payor the service is outside the hospice bundle so it can be processed separately.

Using GV with Q5 or Q6 when covering for the attending

When the attending physician is away and another doctor covers the visit, the claim must show two things, the coverage arrangement and that the service is related to the terminal illness. Add Q5 (reciprocal billing) or Q6 (fee for time or locum) and add GV on the same CMS 1500 line in Box 24D. Put the coverage modifier first. Example, 99213 Q6 GV. Keep a note that names the regular attending, the coverage dates, and why coverage was needed. If the service is unrelated, use GW instead of GV, and for facility claims, show unrelated care with Condition Code 07.

Documentation to support GV or GW

Your note and claim should tell the same simple story. Show that the patient is in hospice, name the attending, and state in plain words whether today’s service is related or not related to the terminal illness. Place the right modifier on each line so the claim matches the chart.

Keep these in the record

• Hospice election on file that names the attending.
• One clear sentence in the note says related or unrelated to the terminal illness.
• Diagnosis and plan that support that statement.
• For GV, proof that you are the attending and not employed by the hospice or paid under arrangement.
• For GW, a brief reason the service is unrelated, for example, a diabetes follow-up while the terminal diagnosis is lung cancer.
• For facility claims, Condition Code 07 on the UB 04 for unrelated care, and a short note that backs it up.
• For covering physicians, dates and details of the Q5 or Q6 arrangement, and the name of the regular attending.
• For suppliers and DME, a valid order, medical necessity, and a note that the item is unrelated to the terminal diagnosis.
• Modifiers are placed on every affected line on the CMS 1500.
• Signature, credentials, and date on the note.

Conclusion

Picking the right modifier is simple when you slow down and ask two questions. Are you the attending named on the hospice election, and is today’s service related to the terminal illness? If yes to both, use GV. If the service is unrelated, use GW. On facility claims, use Condition Code 07 to show unrelated care.

Keep your documentation tight. State related or unrelated in one clear sentence, match the diagnosis and plan to that choice, and place the modifier on every affected line in Box 24D. When a covering physician steps in, add Q5 or Q6 before GV. These small steps prevent edits, avoid B9 denials, and help the payor process the claim correctly the first time.