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Billing with the GV Modifier

When a patient elects hospice coverage, he/she waives all right to Medicare Part B payment for professional services related to the treatment and management of his/her terminal illness during the hospice election period. The exception is for professional services of an "attending physician" who is not an employee of the designated hospice nor receives compensation from the hospice for those services. The term "physician" means not only an MD/DO but includes a nurse practitioner.

The attending physician may bill Medicare for Care Plan Oversight and other services provided in the treatment of the hospice patient. The attending physician would append Modifier GV - "Attending physician not employed or paid under agreement by the patient's hospice provider." Medicare considers providers who volunteer at the hospice as employees and therefore should not bill Medicare Part B for attending physician services separately.

The Office of the Inspector General included physician billing for hospice patients in their 2010 Work Plan. They plan to evaluate Medicare payment of physician hospice services to verify both the physician and the hospice are not receiving payment for the physician's services. You can find more information on the Medicare instructions on physician billing for hospice care in the Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) Publication 100-04, Chapter 11, Section 40.