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Thread: Flu Vaccine and Hospice

  1. #1
    Join Date
    Apr 2007
    Louisville Kentucky Chapter

    Question Flu Vaccine and Hospice

    AAPC: Back to School
    I'm really hoping someone can help me. My physician gave one of her Hospice patients the Flu Vaccine. The patient is on Medicare. I submitted the CPT codes of 90656 and G0008, but they denied this with the reason being "Patient is enrolled in a Hospice."
    Will they really not cover the flu vaccine for someone on Hospice or do I just need to resubmit this using the -GW modifier (Service not related to the hospice patient's terminal condition)? It doesn't say anything about a missing modifier, but I'm thinking this might be the problem.

    Thanks for your help ahead of time.

  2. #2
    Join Date
    Apr 2007
    Charleston, South Carolina


    I would check with the Hospice as to who you should bill. Usually when enrolled in Hospice, you bill Hospice. They will be able to tell you if you should bill them or Medicare with the modifier. Its been a while since I have done this to be more help. I am sure Hospice can direct you.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

  3. #3
    Join Date
    Apr 2007
    Louisville Kentucky Chapter


    Thanks Machelle. I'll give that a try then.

  4. #4

    Default flu for hospice

    Quote Originally Posted by JeannieG View Post
    Thanks Machelle. I'll give that a try then.

    did you ever receive an answer for this; i had the same thing happen- resub w the gw and was denied again as provider should not bill for service or be given by that "specialty" we are internal med... do i use gv instead?


  5. #5


    I work at a SNF and when I bill for a flu Vaccine I have to put a 07 condition code.

  6. #6


    If the Dx is unrelated to the hopice admit Dx you append Modifier GW. Any time patient is in hospice, call MC to see what hospice facility they are in & the dates they are enrolled in hospice then call that hospice facility to find out who admitting Dr is & the Dx they were admitted under. This information decides whether you use a GV modifier or GW modifier.

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