The Difference Between GV vs GW Modifier: Learn when To Use Them

Medicare and Medicaid systems regularize a standardized process for allowing medical healthcare providers to facilitate healthcare, provision of medical services, billing and insurance, and almost every aspect included in the haircare industry.

To make the process simple and steady, codes and modifiers are there that help medical providers at every level. Similarly, GV and GW are HCPCS Level II Medicare Hospice Modifiers. What are they and what defines GV vs GW modifiers, here’s everything you need to know.

What is Hospice and how is it associated with the GV vs GW modifier?

Hospice is a space where supportive and palliative care is delivered for critically ill patients and individuals with the least mobility. In order to have the reimbursements for the service rendered to these terminally ill patients at the Hospice healthcare centers, the providers need to bill the hospice contractor. These healthcare providers are paid/employed/ or are part of the Hospice.

What is Hospice and how is it associated with the GV vs GW modifier

However, if the attending physician is not a part or not an employee under the Hospice tag, but performs the services of healthcare to the patients regardless if the patient was admitted into Hospice, then the reimbursement claims for those services will be submitted to Medicare. These claims will be made along with the GV and GW modifiers, assuring that separate payments would be made.

But how does Medicare process GV and GW modifiers?

Modifier GV

GV modifier is added to the claims when a patient is handled for the diagnosis related to Hospice but the physician who is involved in providing healthcare to that particular patient is not paid by or is not an employer of Hospice.

This means that if a patient is admitted to Hospice and the attending physician is not an employee of Hospice, then they will be paid through Medicare for the service related to Hospice even if they are not employed by Hospice. Also, it is important to add the GV modifier in order to ensure timely and proper reimbursements.

Here are some important things to keep in mind;

  • Adding a GV modifier to claims will only be beneficial for non-Hospice physicians. Physicians employed by Hospice should submit their claims to the Hospice contractor.
  • Avoid appending GV modifier in claims, when the physician is not recognized as the Hospice employer treating the patient in the Hospice facility.
  • Adding a GV modifier from the Hospice contractor will only be possible if the patient is eligible for the Hospice programs and plans even if the attending physician is not an employee of Hospice.

Let’s discuss an example to learn about GV modifier more;

Suppose a patient is enrolled in Hospice for the treatment of pulmonary disease and on his visit, he goes to a doctor who is not associated with the treatment performed for pulmonary disease as a Hospice entity.

In this example, the procedure performed for the said disease by the physician who is not associated with Hospice with that certain disease. Hence, the claim will be submitted to Medicare with GV modifiers reported.

GW modifier

GW modifiers are used in the claims when the diagnosis of a patient is not associated with the Hospice diagnosis performed through a physician who is not an employee/paid/ or employed by Hospice.

But how do Medicare process GV and GW modifiers

This means that when a patient is admitted to the Hospice and the attending physician is not a part of the Hospice and the patient received services that are not related to the main issue for which he was initially admitted, the provider must use the GW modifier to the CPT-10 code while they submit their claims to Medicare.

Important guidelines to keep in mind;

  • GW modifiers will not be added to physicians working for Hospice as healthcare providers for a certain disease. Their claims would be submitted to hospice contractors and GW modifiers to ICD-10 codes can only be read through Medicare standards.
  • If a physician is not identified as an attending physician to a patient, GW modifiers would not be used.
  • Appending GW modifiers would be beneficial to the physicians when the beneficiary is a Hospice program enrollee and the physician serving them with the healthcare is not employed for the patient’s condition.

Example to understand;

A hospice enrolled patient goes to the physician for heart failure congestion when the attending physician is not paid by Hospice as a Hospice entity under debridement of the nail.

Here, the procedure performed by the physician was not associated with the physician’s expertise related to Hospice. Therefore, while providing claims, providers must use GW modifiers with the CPT- 11720 (debridement of the nail) code.