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.

Professional services provided by a physician who is employed, or working under an 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 PractitionerServicesPDF” quick resource tool, or the “Billing Hospice Physician and Nurse Practitioner Services” Webpage.

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.

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