CMS Announces GV Modifier for RHC and FQHC Attending Physician Claims

CMS has issued CR 12357 and MM 12357 announcing the use of the GV modifier for Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC). Beginning January 1, 2022, an RHC or FQHC can bill and get payment under the RHC All Inclusive Rate (AIR) or FQHC Prospective Payment System (PPS), respectively, when their employed and designated attending physician provides services during a patient’s hospice election. To get the RHC AIR or payment under the FQHC PPS:

• RHCs must report the GV modifier on the claim line for payment (along with the CG modifier) each day they provide a hospice attending physician service

• FQHCs must report the GV modifier on the claim line with the payment code (G0466 – G0470) each day they provide a hospice attending physician service. This applies when a physician, nurse practitioner, or physician assistant working for or under contract to an RHC or FQHC provides hospice attending physician services to a Medicare patient who has elected hospice. This is effective for dates of service on or after January 1, 2022.