Hospice physician Billing FAQ
The Medicare Claims Processing Manual (CMS Pub.) discusses billing and payment of hospice physician services. 100-04) Ch. 11 40 PDF External When a physician or nurse practitioner (NP) is employed, under contract, or volunteering for the hospice, they are required to bill CGS for professional (hands-on) services related to the terminal illness. The Medicare Part B Carrier/MAC is billed by the independent attending physician/NP if the services are provided.
The per diem does not need to be invoiced separately for administrative tasks because they are included. Additionally, the NP must have been the patient's attending physician at the time the hospice benefit was selected in order for the NP services to be billable separately.
The per diem does not need to be invoiced separately for administrative tasks because they are included. Additionally, the NP must have been the patient's attending physician at the time the hospice benefit was selected in order for the NP services to be billable separately.
The hospice is responsible for separately billing any professional services rendered by a physician who is employed by the hospice or who is working under an arrangement with the hospice. These services can be included in the hospice claim that is submitted to CGS. A physician's service is identified by the appropriate HCPCS code and the revenue code 0657 for the service. A service date, charges, and units all need to be included. You are also required to report the modifier "GV" for services provided by a nurse practitioner who serves as the patient's attending physician. The CGS "Billing Hospice Physician and Nurse Practitioner Services PDF" quick resource tool or the "Billing Hospice Physician and Nurse Practitioner Services" webpage provide additional information.
The physician uses the modifier when billing the Part B MAC for services that are unrelated to the treatment of the terminal condition for which hospice care was chosen.
‘GW’ to indicate services are unrelated to the terminal illness.
Medicare cannot be separately billed for the physician assistant services provided to a hospice beneficiary by a hospice agency.