Action – Denied as – CO B9 Services are not covered because the patient is enrolled in a hospice.
Description: (THESE SERVICES ARE DENIED BECAUSE THE PATIENT IS IN A HOSPICE)
Tips / Resources
There are specific guidelines pertaining to Medicare hospice benefits. Certain Medicare coverage does not apply to a beneficiary that is enrolled in a hospice program.
To determine if a patient is enrolled in a hospice program, contact the Interactive Voice Response Unit (IVR), from which the following data pertaining to the beneficiary can be obtained:
• Hospice effective date
• Hospice termination date (if applicable)
• Servicing contractor number
Certain modifiers apply when the services/providers are not related to hospice:
GV Modifer: Attending physician not employed or paid under agreement by the patient’s hospice provider
GW Modifier : Services not related to the hospice patient’s terminal condition
