The GV modifier is defined by CMS as follows:
“Attending physician not employed or paid under arrangement by the patient’s hospice provider.”
In plain terms, this modifier indicates that the provider is acting as the patient’s attending physician, but is not employed or contracted by the hospice organization, and the care provided is unrelated to the patient’s terminal condition.
This is important because Medicare, under the hospice benefit, expects the hospice provider to manage and cover all care related to the terminal diagnosis. Claims submitted by outside physicians without the GV modifier are likely to be denied as redundant or bundled into the hospice per diem.
When to Use the GV Modifier
The GV modifier should be applied when all the following conditions are met:
- The patient has elected the Medicare hospice benefit.
- The provider is delivering services that are unrelated to the patient’s terminal diagnosis.
- The provider is not employed by or under arrangement with the hospice organization.
- The provider is acting as the attending physician for the unrelated condition.
This modifier is typically used by primary care physicians, specialists, and outpatient providers treating comorbid conditions such as diabetes, hypertension, or heart failure when these issues are not part of the terminal diagnosis.
Billing Example: Proper Use of GV Modifier
A cardiologist follows a hospice patient who has end-stage pancreatic cancer. The patient is also being monitored for chronic congestive heart failure (CHF), which is not part of the terminal diagnosis. During an office visit, the cardiologist evaluates the patient’s CHF.
- CPT Code: 99214
- ICD-10 Code: I50.22 (chronic systolic heart failure)
- Modifier: GV
This claim indicates that the service was performed by an unaffiliated attending physician for a diagnosis unrelated to the terminal illness. The GV modifier helps ensure the claim is processed separately from the hospice per diem.
GV vs. GW Modifiers: Key Distinctions
While GV indicates an unaffiliated attending physician providing unrelated care, the GW modifier is used when the hospice provider themselves deliver services unrelated to the terminal illness.
| Modifier | Description |
|---|---|
| GV | Unrelated care by non-hospice-affiliated physician |
| GW | Unrelated care by hospice-employed or contracted provider |
Knowing when to use each modifier is essential to avoid denials, as applying the wrong one can confuse payers about employment relationships and responsibility for care.
Documentation Requirements for GV Modifier Claims
To ensure proper reimbursement, the medical record must clearly support the use of the GV modifier. This includes:
- Documentation of the terminal diagnosis as identified by the hospice plan of care.
- Evidence that the service provided is unrelated to the terminal illness.
- Statement of the provider’s role as the patient’s attending physician for unrelated conditions.
- Confirmation that the physician is not affiliated with the hospice provider.
Failure to document these elements increases the risk of claim denial or post-payment audit.
Common Billing Pitfalls and How to Avoid Them
- Submitting claims without verifying hospice status
Always confirm if the patient has elected hospice using Medicare’s Common Working File (CWF) or your clearinghouse tools. - Omitting GV when applicable
If a patient is under hospice and the service is unrelated, failure to include GV will likely result in a denial. - Using GV with hospice-affiliated physicians
This is incorrect. Instead, GW might be appropriate if the care is unrelated. - Using GV for services related to the terminal diagnosis
These services are the financial responsibility of the hospice agency. - Poor documentation
Insufficient or vague documentation will undermine the claim’s validity, even if the modifier is applied correctly.
Payer-Specific Considerations and Medicare Compliance
While the GV modifier is primarily a Medicare construct, some commercial payers may adopt similar logic. However, it’s crucial to verify:
- The payer’s policy on hospice coverage
- Modifier acceptance (GV may not be recognized outside Medicare/Medicaid)
- Documentation or prior authorization requirements
For Medicare, the modifier serves not only a billing function but also a compliance role by clearly defining financial responsibility and ensuring services are not double-paid.
Best Practices for GV Modifier Use
- Integrate hospice status checks into patient intake workflows.
- Train billing staff and providers on modifier logic and documentation.
- Develop templates for notes that clarify unrelated diagnoses and provider roles.
- Audit hospice claims monthly to identify missing or misused modifiers.
- Consult with hospice agencies when in doubt about diagnosis overlap or provider status.
Conclusion: Use the GV Modifier to Protect Reimbursement and Ensure Compliance
The GV modifier plays a critical role in allowing physicians who are not affiliated with a hospice organization to bill Medicare for medically necessary services unrelated to a patient’s terminal illness. Correct use of this modifier not only facilitates appropriate payment but also helps distinguish provider roles, reduces billing confusion, and supports compliance with CMS guidelines.
To use the GV modifier effectively, providers must be proactive in verifying hospice status, documenting the unrelated nature of services, and ensuring their billing systems support accurate claims submission.