If a patient is transported by ambulance to hospice prior to the initial assessment and development of the plan of care, what destination modifier do I use?

Answer
There is no specific modifier designated for hospice. You would use the appropriate HCPCS modifier based on the location of where the patient is receiving the service. The most common HCPCS modifiers for hospice providers would be:

  • H (hospital)
  • E (residential, domiciliary, custodial facility) or
  • N (skilled nursing facility)

Please keep in mind that all other coverage requirements must be satisfied. For instance, a transport from "R" (residence) to "E" (residential, domiciliary, custodial facility) would not be covered because it is essentially a transport between two residences.

If it is determined that the claim should be submitted to Medicare Part B, please consider adding HCPCS modifier GW (service not related to the hospice patient’s terminal condition) to your claim.

Resource
CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, chapter 15 (PDF, 421 KB)- Ambulance, Section 30.A.

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