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:
- The beneficiary is in a hospice episode/period of care on the date of service.
- The need for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item is not related to their hospice condition.
- You should have a valid Hospice Election Statement Addendum on file. A complete list of the requirements for this document is published here: CMS Benefit Policy Manual, Ch. 9, Section 20.2.1.2..
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:
- Hospice and GW Modifier Prepayment Reviews
- Medicare Minute ℠ Hospice and GW Modifier
- "To The Point" Consolidated Billing and Hospice
CMS and OIG Resources:
- CMS Hospice Educational Resources
- CMS Hospice Page
- Medicare Improperly Paid Suppliers an Estimated $117 Million Over 4 Years for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Hospice Beneficiaries, A-09-20-03026
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. |