Billing

How to Bill Services for Hospice Patients

For services related to hospice diagnosis

Primary (Attending) Physician

Bill Medicare Part B or applicable intermediary using your usual electronic system and the applicable CPT E&M code for the service. Include the GV modifier, which indicates that the attending is not employed by Hospice but is treating the terminal condition.

If you are authorized to give medication or perform a procedure, bill the medication and the technical component to Hospice of Palm Beach County and the professional component to your Part B carrier.

You will be paid 80% of the Medicare allowable.  You may bill the patient, or their secondary insurance, for the remaining 20%. Medicare reimburses the physician.

Consulting (or Second) Physician

You must sign a Physician Consulting Agreement with Hospice of Palm Beach County.

Physician bills Hospice of Palm Beach County using applicable CPT codes for both professional and technical components using HCFA 1500 form. Hospice bills Medicare Part A.

You will be paid 80% of the Medicare allowable and will not bill the patient or a secondary insurance for any component of the bill. Hospice of Palm Beach County reimburses the consulting physician.

For a non-hospice diagnosis
Attending and Consulting Physicians

Bill Medicate Part B or applicable intermediary using your usual electronic system and the applicable CPT E&M code for your service. Include the GW modifier, which indicates the services are not related to the terminal diagnosis.

If you receive a denial because the patient is on hospice, request a denial letter. Include this letter with your resubmission.

You will be paid 80% of the Medicare allowable. You may bill the patient or their secondary insurance for the remaining 20%. Medicare reimburses the physician.