Doctor treats a hospice patient: Modifier GV, GW, or both? Part B providers who are not paid by a hospice but nonetheless treat that hospice's patients for non-end-of-life care -- for example, sprains or dermatological issues -- are able to bill Medicare for their services. There are two claim modifiers that seem relevant to such treatment: GW (Service unrelated to the patient's terminal condition) and GV (Attending physician not employed or paid under agreement by the patient’s hospice provider). Readers of our practice management weekly would like to know the difference among the sort of claims that would require GV, GW, or both modifiers. It will be helpful to hear how different scenarios would affect this billing -- for example, if the patient has Part A Medicare (which covers hospice) but not Part B.

GV and GW solve different problems, and they can be used together. GV is about who the physician is in relation to the hospice. You use GV when the clinician is the patient's hospice "attending physician" (the MD/DO the patient designates to oversee care) and that attending is not employed by, or paid under arrangement by, the hospice. GV doesn't, by itself, establish that the service is unrelated to the terminal condition; it just flags that the attending is independent of the hospice so Part B payment rules apply appropriately. GW is about what the service is. You use GW when the service is unrelated to the patient's terminal condition (and unrelated to conditions related to that terminal condition) so it should bypass hospice responsibility and be paid by Medicare separately. In real-world billing workflows I've seen in practices, "both" is common when an independent attending physician provides an unrelated service: GV identifies the independent attending role; GW identifies the unrelated nature of the specific service. If the physician is not the hospice attending (e.g., a dermatologist treating a rash) GV typically isn't applicable; GW may still be necessary if the service is unrelated and you need it to process outside the hospice. On the Part A/Part B point: hospice is a Part A benefit, but physician professional services are generally paid under Part B rules. If the patient has no Part B coverage, the presence of GV/GW won't create Part B eligibility; it just affects correct routing/processing when Part B is in force. In practice, the safest operational step is confirming (a) whether the provider is the designated attending, and (b) whether the diagnosis is clearly unrelated to the terminal condition/related conditions, because that drives GV vs GW vs both.

If a hospice patient needs mental health services unrelated to their terminal condition, you need the GW modifier. You also need GV if the provider isn't the main hospice doctor. I've seen claims get denied for missing these. Just double-check the patient's coverage and the specifics of their hospice plan before you submit anything. It saves you from billing headaches later. If you have any questions, feel free to reach out to my personal email

Here's my rule of thumb. GV is for when you're treating a hospice patient but you're not their main doctor. GW is for anything unrelated to their hospice diagnosis. I recently treated a hospice patient for an unrelated wound repair, used both GV and GW, and the claim went through. Just remember to check their insurance first. If they only have Part A coverage, you can't bill Part B. If you have any questions, feel free to reach out to my personal email

When a Part B provider treats a hospice patient for non-end-of-life care, understanding the difference between GV and GW modifiers is key to correct Medicare billing. The GW modifier is used to indicate that the service provided is **not related to the patient's terminal condition** and therefore is separately payable under Part B. For example, if a hospice patient comes in for a sprained ankle or a dermatology issue unrelated to their terminal illness, the GW modifier signals that Medicare should cover the service even though the patient is enrolled in hospice under Part A. The GV modifier, on the other hand, applies when the **attending physician is not employed or paid under agreement by the patient's hospice provider**. This modifier communicates that the provider delivering the service is independent of the hospice organization, which is relevant when coordinating payment responsibilities and avoiding duplication of coverage. In practice, a claim may include both modifiers if a non-hospice physician treats a hospice patient for a service unrelated to the terminal condition while also not being employed or paid by the hospice. For instance, if a patient with Part A hospice coverage is treated by an independent dermatologist for a skin condition unrelated to their terminal illness, the claim would require both GV and GW to ensure proper Medicare reimbursement under Part B. It is important to note that these modifiers are only relevant for services **not covered by the hospice benefit** under Part A. Services related to the terminal condition or provided by the hospice team itself would not use GW or GV. Clear documentation of the reason for the visit, the independence of the provider, and the medical necessity of the service is essential to avoid denials and support proper billing. Name: Abhishek Bhatia Title: CEO, Pawfurever LinkedIn: [https://www.linkedin.com/in/abhatia02/](https://www.linkedin.com/in/abhatia02/)