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** Condition Code 07-The patient has elected hospice care; but the provider is not treating the patient for the terminal condition. ** GW modifier-Service not related to the hospice patients terminal condition. ** GV modifier-Attending physician not employed or paid under agreement by the patientâs hospice provider.
A hospice provider must obtain a physician certification that an individual is terminally ill and hospice services must be reasonable and necessary for the palliation or management of the terminal illness and related conditions. A hospice plan of care must be established before services are provided. Payment for hospice services is made to a designated hospice provider using the CMS annually published Medicaid hospice rates that are effective from October 1 of each year through Sept 30 of the following year.