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Writer's pictureOhtred Ragnarson

PROMBS: Everything You Need to Know about Hospice Modifier GW

Updated: May 9

Enhance your wound care billing efficiency using Hospice Modifiers GW and master their correct application to secure successful reimbursements for medical practices. The GW modifier represents a unique code in medical billing, signifying that a service or procedure given to a hospice patient is unrelated to their terminal illness or specific hospice care. This modifier is crucial when a hospice patient receives a service unconnected to their terminal illness. For instance, a hospice patient might need dental services, which do not pertain to their terminal condition. In such scenarios, applying the GW modifier clarifies that the dental service is separate from hospice care.

Medicare, which covers hospice care, allows hospice providers to bill for services rendered to patients under a hospice care plan. While Medicare's comprehensive hospice benefit encompasses all services linked to a patient’s hospice care, services unrelated to their terminal illness or hospice care require the GW modifier. This modifier is used alongside the relevant Healthcare Common Procedure Coding System (HCPCS) code, placed after the HCPCS code. It's important to remember that the GW modifier is specifically for Medicare hospice patients, and other insurers might have different guidelines for hospice care billing.


Hospice Modifiers in Medicare Context

Medicare uses both GV and GW modifiers for hospice patients. The GV modifier denotes services associated with a patient’s hospice care, whereas the GW modifier indicates services unrelated to the patient’s hospice care.


Distinguishing Between GV and GW Modifiers

The GV modifier signifies that a service or procedure pertains to a patient’s hospice care. Conversely, the GW modifier is employed for services or procedures not connected to a patient’s hospice care, indicating services provided under a hospice care plan but unrelated to the hospice care itself.


Scope of GW Modifier Beyond Medicare

Primarily, the GW modifier is applicable to Medicare hospice patients. The Centers for Medicare and Medicaid Services (CMS) mandates that all hospice services billed to Medicare include either a GV or GW modifier, with the GW modifier indicating services unrelated to hospice care.


Essential Aspects of Hospice Modifier GW

Key points regarding the GW modifier include:

  • It indicates services not linked to a patient’s hospice care.

  • It is exclusive to Medicare hospice patients.

  • It should be coupled with the appropriate HCPCS code.

  • On claim forms, the GW modifier follows the HCPCS code.


Order of Placement: GW Modifier and HCPCS Code

The claim form should list the HCPCS code first, succeeded by the GW modifier.

In summary, the GW modifier is an essential component for hospice providers in billing Medicare for services given to hospice patients that are extraneous to their terminal illness or hospice care. Proper usage of this modifier is crucial for accurate billing and coding in hospice services. It must always accompany the relevant HCPCS code, positioned after it on the claim form.

Medical Billers and Coders (MBC), a seasoned medical billing and coding firm, specializes in Wound Care Billing Services. MBC's team of expert medical coders and billers, with extensive industry experience, handles all facets of wound care billing, including coding, claim submission, payment processing, and managing denials.

MBC collaborates closely with wound care providers to ensure precise coding and timely submission of claims, aiding in maximizing reimbursements and reducing claim rejections. For more information on MBC’s wound care billing services, contact them at info@prombs.com or call at (725) 237-2757.

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