Modifier GV- Interactive Audio and Video Telehealth

Modifier GV identifies services furnished by a patient's designated attending provider who is not employed or paid under arrangement by the hospice.

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What is Modifier GV?

Modifier GV is used when the patient-designated attending physician, nurse practitioner, or physician assistant furnishes professional services to a Medicare hospice beneficiary and is not employed by or paid under arrangement with the patient's hospice.

Current CMS hospice instructions specifically recognize physicians, NPs, and PAs as applicable attending practitioners for GV billing.

The modifier is important because a beneficiary's election of hospice changes how Medicare pays for services related to the terminal illness.

GV allows Medicare to identify separately billable professional services furnished by the beneficiary's independent designated attending practitioner when applicable requirements are satisfied.

When to Use Modifier GV

Hospice Beneficiary: The patient has an active Medicare hospice election.

Designated Attending Provider: The practitioner is the attending physician, NP, or PA selected by the patient.

Independent of Hospice: The attending practitioner is not employed or paid under arrangement by the hospice.

Related Professional Service: The practitioner furnishes an applicable professional service related to the patient's terminal condition.

Medicare Claim: GV is reported on the applicable professional claim to identify the attending-provider circumstance.

When NOT to Use Modifier GV

Service Is Unrelated to Terminal Condition: Modifier GW generally applies when the service is unrelated to the hospice patient's terminal condition.

Practitioner Is Not the Designated Attending Provider: GV does not apply simply because a physician or practitioner treats a hospice beneficiary.

Practitioner Is Paid by Hospice: Services furnished under an arrangement with the hospice generally fall under the hospice payment structure.

Hospice Election Has Ended: GV is not required solely because the patient previously received hospice care.

To Establish Medical Necessity: GV identifies the hospice billing relationship and does not independently establish coverage.

Billing Example

A Medicare beneficiary elects hospice and designates a physician as the attending physician.

The physician is independent and is neither employed by nor paid under arrangement with the patient's hospice.

The physician provides a medically necessary professional service related to the patient's terminal condition.

The physician reports the applicable procedure code with Modifier GV so Medicare can identify the service as being furnished by the patient's independent designated attending physician.

Documentation Requirements

Hospice Election: Verify and document the patient's active hospice status.

Attending Provider: Records should establish that the practitioner is the patient's designated attending provider.

Provider Relationship: Documentation should support that the practitioner is not employed or paid under arrangement by the hospice.

Service Furnished: Document the professional service represented by the CPT or HCPCS code.

Relationship to Terminal Condition: Establish whether the service relates to the hospice terminal illness or related conditions.

Medical Necessity: Documentation should support why the professional service was reasonable and necessary.

Claim Consistency: Provider, hospice, procedure, diagnosis, and modifier information should accurately reflect the circumstances.

Billing and Claim Considerations

Modifier GV is a critical Medicare hospice modifier because Medicare generally expects services related to the beneficiary's terminal illness to be provided or arranged through the hospice.

An exception exists for applicable professional services furnished by the patient's designated attending practitioner who is independent of the hospice.

CMS's current claims guidance states that professional services furnished to hospice beneficiaries by applicable attending practitioners are reported with GV when the practitioner is not employed or paid under arrangement by the hospice.

The distinction between GV and GW is particularly important. GV identifies the relationship between the hospice beneficiary and independent designated attending practitioner. GW identifies services that are unrelated to the patient's terminal condition.

CMS also instructs Medicare contractors to use hospice enrollment information when validating claims containing GV or GW.

Common Billing Mistakes

Confusing GV With GW: GV identifies an independent designated attending practitioner, while GW identifies a service unrelated to the terminal condition.

Provider Is Not the Designated Attending: Treating the patient does not automatically make a practitioner eligible to report GV.

Provider Is Employed by Hospice: GV requires the applicable attending practitioner to be independent of the hospice payment arrangement.

Missing Hospice Verification: Providers should confirm the patient's hospice election before billing.

Incorrect Relationship to Terminal Condition: The record should establish whether the service is related or unrelated to the hospice diagnosis.

Missing Additional Modifier: Substitute physician arrangements may require GV together with Q5 or Q6 when applicable. CMS specifically recognizes these combinations.

Common Denial Reasons

GV Is Missing: CMS may deny applicable professional claims during a hospice election when the required GV or GW modifier is absent.

Provider Is Not the Attending Practitioner: Medicare records do not support the practitioner's designated attending status.

Provider Relationship Is Incorrect: The practitioner is employed or paid under arrangement by the hospice.

Service Should Be Billed Through Hospice: The service falls within the hospice payment arrangement rather than separate professional billing.

Documentation Is Insufficient: Records do not support the professional service or hospice billing circumstances.

Incorrect Modifier: GW or another modifier better represents the service.

Modifier GV vs. Modifier GW

Modifier GV: Identifies applicable services furnished by the patient's designated attending practitioner who is independent of the hospice.

Modifier GW: Identifies services that are unrelated to the hospice patient's terminal condition.

This distinction is important because GV describes the attending-provider relationship, while GW describes the relationship between the service and the terminal condition.

CMS continues to use both modifiers when processing professional claims for beneficiaries with active hospice elections.

Frequently Asked Questions

Can a nurse practitioner or physician assistant use Modifier GV?
Yes. Current CMS guidance recognizes applicable attending physicians, nurse practitioners, and physician assistants when GV requirements are satisfied.

Is Modifier GV used when a service is unrelated to the terminal illness?
Generally, no. Modifier GW identifies services unrelated to the hospice patient's terminal condition, while GV applies to applicable services furnished by the independent designated attending practitioner.