Hospice physician Billing FAQ

When can hospices bill Medicare for physician services?

Billing and payment of hospice physician services are discussed in the Medicare Claims Processing Manual (CMS Pub. 100-04) Ch. 11 § 40External PDF. Physician and nurse practitioner (NP) services that are related to the terminal illness and are professional (hands-on) in nature are billed to CGS when the physician or NP is employed, under contract, or is a volunteer of the hospice. If the services are provided by an independent attending physician/NP, the physician/NP bills the Medicare Part B Carrier/MAC.
Administrative activities are included in the per diem, and not separately billable. In addition, in order
for the NP services to be separately billable, the NP must be the patient’s attending physician at the time
the hospice benefit was elected.

How are physician's services billed to Medicare?

Professional services provided by a physician who is employed, or working under arrangement with
the hospice are separately billable by the hospice and can be included on the hospice claim that is
submitted to CGS. Revenue code 0657 is used to indicate a physician's service, along with the
appropriate HCPCS code for the service provided. Units, charges and a service date must also be
included. For services provided by an NP serving as the patient's attending physician, you must also
report the modifier 'GV'.

For additional information, refer to the CGS “Billing Hospice Physician and Nurse Practitioner
ServicesPDF” quick resource tool, or the “Billing Hospice Physician and Nurse Practitioner Services” Web
page.

What if the physician's services were unrelated to the patient's terminal prognosis?

If the physician's services are not related to the treatment of the terminal condition for which
hospice care was elected, the services are billed by the physician to the Part B MAC using the modifier
'GW' to indicate services are unrelated to the terminal illness.\\\\

Can a physician assistant who is employed by the hospice furnish billable services to a hospice patient?

Services provided by a hospice agency's physician assistant to a hospice beneficiary are not
separately billable to Medicare.

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