Modifying Editing for Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) Hospice Physician Services When the Beneficiary has Medicare Advantage
The purpose of this Change Request (CR) is to adjust the editing process for RHC and FQHC claims that include a GV modifier. This is particularly important when billing for hospice attending physician services provided by designated RHC or FQHC practitioners during a patient's hospice election, especially for beneficiaries enrolled in a Medicare Advantage plan. CMS previously issued CR 12357, titled "Implementation of the GV Modifier for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for Billing Hospice Attending Physician Services." CMS has been made aware of an issue where claims are being rejected for beneficiaries with Medicare Advantage Plans. Consequently, this CR is being developed to rectify this problem.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: April 17, 2025
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