Hospice and Billing of Evaluation and Management Services
When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payment for services that are related to the treatment and management of his/her terminal illness during any period his/her hospice benefit election is in force, except for professional services of an "attending physician." For purposes of administering the hospice benefit provision, an attending physician means a physician who: is a doctor of medicine or osteopathy; and is identified by the individual, at the time he/she elects hospice coverage, as having the most significant role in the determination and delivery of their medical care.
When an attending physician is under a payment arrangement with the hospice, services related to the patient's terminal condition should be billed by the hospice to its intermediary. Hospice physician services are paid by the hospice intermediary at 100 percent of Medicare approved charges.
An attending physician who provides services that are not furnished under a payment relationship with the hospice should bill Medicare Part B for these services. These services are reimbursed under the physician fee schedule.
The attending physician would code services with the GV modifier."Attending physician not employed or paid under agreement by the patient's hospice provider" when billing his/her professional services furnished for the treatment and management of a hospice patient's terminal condition.
Medical documentation should note if the provider is the attending physician selected by the beneficiary. Use of the GV modifier attests that the attending physician is under no payment arrangements with the hospice.
See National Coverage Provision (NCP) PHYS-051, Indication and Limitations for Coverage, C. Physicians Services, under numbers 1, 3 and 4 and the Coding Guidelines number 2 for the guidelines on Hospice care and attending physician services.
