Wiki GW modifier

[drampas3418]

so i have a claim that was paid by aetna medicare ppo but they are now taking their money back stating the patient was enrolled in a hospice. ok however if the patient had straight medicare i would have sent the claim with a modifier gw. aetna does not recognize this modifier. the representatives have not idea what to do to get my claim paid. anyone here have any experience with this?

 

[csperoni]

Depending on whether your services were related to the terminal illness, you might need to bill traditional Medicare. I also believe your physician needed to be listed as part of the patient's care team when enrolled in hospice.
Being in oncology, we never bill with -GW, but rather -GV and are the attending physician not employed by hospice.

https://www.medicare.gov/what-medicare-covers/what-part-a-covers/how-hospice-works

https://www.medicare.gov/coverage/hospice-care

If you would have used -GW, then I'm assuming the services you provided were not related to the terminal illness. As long as the patient was still paying their premiums, it would seem Aetna should be the responsible party. If that is the case, I would ask Aetna for their policy related to this. Did you try -GW and Aetna denied? Did you dispute (in writing) the take back?