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July 12, 2023

GW Modifier Usage for Hospice Patients

GW - Service not related to the hospice patient's terminal condition or a related condition. Use of the GW modifier means that the item or service is not related to the hospice patient's terminal condition.

Suppliers must append the GW modifier to the applicable HCPCS codes if both of the following are true:

  1. The beneficiary is in a hospice episode/period of care on the date of service.
  2. The need for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item is not related to their hospice condition.

Claims for dates of service during a hospice episode/period of care will be denied unless the GW modifier is appended. To correct a claim denial due to GW modifier omission, verify that the GW modifier should be appended and submit a new claim.

When more than four modifiers are required, replace the fourth modifier with modifier 99, and add the overflow modifiers to Item 19 of the CMS-1500 claim form or its electronic equivalent.

Hospice episode/period of care information is available in the myCGS portal and through the Interactive Voice Response (IVR).

Please review the following CGS Resources for use of the GW modifier for hospice patients:

CMS and OIG Resources:

Publication History

November 16, 2020 Originally published with title “Billing Reminder GW Modifier.” Effective for claims submitted on or after December 1, 2020, with dates of service on or after September 7, 2020.
November 29, 2022 Revised to include instructions on how to correct the claim.
July 12, 2023 Revised: Changed the title of the article, added information about the Hospice Election Statement Addendum, updated claim correction instructions, and added CGS and CMS resources.


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