Wiki Question-

[ndeane@netzero.net]

Just a quick question..

I have a patient that received a Prolia injection in the office. The patient has a Medicare advantage plan. The claim was denied due to the patient being enrolled under Hospice. Our local Medicare advantage plan stated that we need to bill Medicare. Would a modifier need to be on the CPT codes signifying that the patient is in Hospice care?

Any feedback would be very helpful!!!

Thank you,

Nicole

 

[TammyHF]

The claim needs to be submitted with appropriate Hospice modifier:

GV - Attending physician not employed or paid under agreement by the patient's hospice provider.
GW - Service not related to the hospice patient's terminal condition