I'm not certain what CPT code you are asking about because Encoder Pro states that this is an invalid code and I tried to google it I was unable to locate any information on this code. I'm guessing you may have a typo in the subject line of your question.
My general response to the question of using modifiers to override a Medicare denial PR-B9 "Patient is enrolled in Hospice", you have 2 modifier options GV and GW.
Modifier GV is used when the patient is receiving hospice care/services and the treatment/services provided
are related to the patient's terminal diagnosis but the attending physician provider the services is
NOT employed by the hospice agency managing the patient's terminal condition. Here is a decision tree from Novitas on whether or not modifier GV should be appended to the service you are submitting for reimbursement outside of the hospice benefits.
Modifier GW is used when the patient is receiving hospice care/services and the treatment/services submitted on the claim are
not related to the patient's terminal diagnosis. Here is the Novitas decision tree for when to use modifier GW.
It is particularly important to submit the correct modifier on your claims because if the patient has coverage which would pay secondary to hospice benefits coverage by traditional Medicare. It is particularly important for patients who have Medicare Advantage (MA) - Medicare Part C because the MA plan cannot apply benefits to any claims which have not be submitted to traditional Medicare.
- If traditional Medicare denies the service as not covered under the hospice benefits, then the MA plan will then consider the claim as the primary carrier for the claim and apply the MA plan's benefits..
- If traditional Medicare applies benefits to the claim under the hospice benefits, then the MA plan will coordinate the benefits so that patient's cost share is based on the benefits of their MA plan.
You cannot simply append the GV or GW modifier to the services and submit the claim directly to the MA plan for consideration as the MA plan requires a copy of traditional Medicare's remit showing either payment or denial by traditional Medicare. Many providers submit claims to the MA plan directly with either the GV or GW modifier and the MA plan is required to deny the claim with a message to the provider to submit to traditional Medicare per the claims processing manual.