Understanding the GW Modifier
The GW modifier is used when submitting Medicare claims for services that are unrelated to a patient’s hospice care. This ensures that Medicare processes the claim separately from hospice-covered services.
When to Use the GW Modifier
Use the GW modifier if:
The patient is enrolled in hospice.
The service provided is unrelated to the hospice diagnosis or terminal condition.
The provider is billing Medicare separately from the hospice provider.
Documentation supports that the service is not part of the hospice treatment plan.
Ensuring Proper Documentation
Clearly document why the service is unrelated to the hospice diagnosis.
Include any necessary supporting notes or physician statements.
Resubmitting a Claim with Paid Zero Status and CO-B9 HE-N90
Duplicate the claim by clicking on the three dots.
Add the GW modifier to each claim line.
Certify and resubmit by clicking on the certification statement.
Finalize the original claim by selecting "Finalize Claim" from the options menu (ellipse icon).
