Medical practices find the hospice modifiers confusing, and confusion leads to denials and payment delays.

Use the decision trees below to help you determine if the service is separately billable once a patient has elected hospice and if so, how to bill it.

There are two decision trees:

• one for the attending physician (who is the physician, nurse practitioner or physician assistant designated by the patient when they elect hospice)
• one for all other physicians, PAs and NPs

Walk through the decision tree to see which modifier to use, modifier GW or modifier GV. For a detailed explanation, read the article Billing physician services for hospice patients