"GV" modifier Attending physician is not employed or paid under agreement by the hospice:

• Physician has been designated by the patient as the attending physician
• Attending Physician is not an employee of the hospice
• Services are related to the hospice patient's terminal illness

"GV" modifier Attending physician is not employed or paid under agreement by the hospice and "Q5" modifier Services being billed by the attending physician were provided by a covering physician:

• Physician is covering for a hospice patient's designated attending physician
• Physician is not an employee of the hospice
• Services are related to the hospice patient's terminal illness

"GW" modifier Service is not related to the hospice patient's terminal condition:

• Physician has been designated by the patient as the attending physician
• Attending physician is not an employee of the hospice
• Services are NOT related to the hospice patient's terminal illness

More detailed information on the modifiers used for billing physician services for hospice patients:
Revision of Part B Billing for the Attending Physician of a Hospice Patient:

Effective April 1, 2002, the Centers for Medicare/Medicaid Services (CMS) have revised the Medicare Part B billing manual sections that relate to attending physician claims for hospice beneficiaries.

When a Medicare beneficiary elects hospice care, he/she may designate an attending physician, not employed by the hospice, in addition to receiving care from hospice-employed physicians. At the time of admission, the hospice agency must send a Notice of Admission to the Part B Intermediary that identifies the hospice, the attending physician and the terminal diagnosis for each hospice patient.

Supervisory activities such as establishing, reviewing and updating care plans as well as supervising care and services are considered part of the Hospice Medicare benefit and should be provided by the hospice medical director. The professional services of a non-hospice affiliated attending physician for the treatment and management of a hospice patient's terminal illness are not considered "hospice services".

When billing for professional services furnished for the treatment and management of a hospice patient's terminal condition, the attending physician should use the appropriate CPT code with the addition of the "GV" modifier "Attending Physician is not employed or paid under agreement by the patient's hospice provider".

If another physician covers for the designated attending physician, the services of the substituting physician should be billed by the physician, designated as the attending by the patient, using the "GV" modifier in conjunction with the "Q5" modifier "services being billed by the attending physician were provided by a covering physician".

For services provided to hospice patients that are not related to the patient's terminal condition, attending physicians should use the appropriate CPT code along with the "GW" modifier "Service is not related to the hospice patient's terminal condition".

The best resource for information on billing Medicare Part B for hospice patients is your State's Part B Intermediary.