GV and GW Modifiers for Hospice Claims- Explained

Hospice claims can get denied quickly when the payor cannot tell whether the service was related or unrelated to the patient’s terminal illness. This is where GV and GW modifiers become important.

These modifiers tell the payor how the service should be handled. GV is used when the hospice patient’s named attending physician bills for care related to the terminal condition. GW is used when the service is unrelated to the terminal condition and should be paid outside the hospice benefit.

The real problem starts when the billing team has to decide this after the claim is already denied. By then, staff are checking notes, calling the hospice, reviewing the election record, correcting claims, and explaining delays to patients or providers. This guide breaks down GV and GW in a practical way so your team can choose the right modifier before the claim goes out.

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.

Can GV and GW Be Used Together?

GV and GW should generally not be used together on the same claim line because they describe different situations. GV is used when the named attending physician bills for care related to the hospice patient’s terminal illness. GW is used when the service is unrelated to the terminal illness. Since one service line cannot usually be both related and unrelated at the same time, the billing team should choose the modifier that matches the service. If the service is related, use GV when the attending physician rules are met. If the service is unrelated, use GW on professional claims or Condition Code 07 on facility claims.

When Not to Use GV or GW

Do not use GV or GW only because the patient is in hospice. The modifier must match the provider’s role, the type of claim, and whether the service is related or unrelated to the patient’s terminal condition.

Do Not Use GV When:

• The physician is not the attending physician named on the hospice election.
• The physician is employed by the hospice or paid under arrangement.
• The service is unrelated to the terminal illness.
• The claim is a UB-04 facility claim.
• The hospice is responsible for billing the related service.

GV should only be used when the named attending physician bills for care related to the terminal condition and is not employed or paid by the hospice.

Do Not Use GW When:

• The service is related to the terminal illness.
• The claim is for the attending physician’s related hospice care.
• The documentation does not clearly show why the service is unrelated.
• The claim is a UB-04 facility claim.
• The service should be billed under the hospice benefit.

GW should only be used when the service or item is unrelated to the hospice patient’s terminal condition. For facility claims, use Condition Code 07 instead of GW to show that the service is unrelated.

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.

How to Use GV with Q5 or Q6 for Covering Physicians?

When the attending physician is not available, another physician may see the hospice patient on their behalf. In this case, the claim needs to show two things:

1. The visit was covered by another physician
2. The service was related to the patient’s terminal illness

That is why Q5 or Q6 is used with GV.

• Q5 shows a reciprocal billing arrangement, where another physician covers for the attending.
• Q6 shows a locum tenens or fee-for-time arrangement.
• GV shows the service was related to the terminal illness and billed for the attending physician’s role.

On the CMS-1500 claim, place the coverage modifier first, then GV.

Examples:

The medical record should clearly mention the regular attending physician, the covering physician, the coverage dates, and why the covering physician saw the patient.

Do not use GV if the service is unrelated to the terminal illness. In that case, use GW on professional claims. For unrelated facility claims, use 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

GV and GW are not just hospice modifiers. They decide how the payor reads the service and whether the claim should be paid under the right billing path.

The easiest way to choose correctly is to check two things before the claim goes out: who provided the service and whether the service was related to the terminal illness. If the named attending physician provides related care, GV is the right modifier. If the service is unrelated to the terminal illness, GW should be used on professional claims. For facility claims, unrelated care should be reported with Condition Code 07.

Most denials happen when the claim does not clearly tell this story. A missing modifier, wrong modifier, or unclear note can make a payable service look like it belongs under the hospice benefit. That creates avoidable denials, follow-up work, and delayed reimbursement.