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HCPCS Modifier GW

Service not related to the hospice patient's terminal condition

Short Descr	Service unrelated to term co
Medium Descr	Service unrelated to term co
Coverage	Special coverage instructions apply
MCM	4175-5
Added Date	1/1/2002

Modifiers

G0-GZ G Modifiers

G0 Telestroke

G1 Urr reading of less than 60

G2 Urr reading of 60 to 64.9

G3 Urr reading of 65 to 69.9

G4 Urr reading of 70 to 74.9

G5 Urr reading of 75 or greater

G6 Esrd patient <6 dialysis/mth

G7 Payment limits do not apply

G8 Monitored anesthesia care

G9 Mac for at risk patient

GA Liability waiver ind case

GB Claim resubmitted

GC Resident/teaching phys serv

GE Resident prim care exception

GF Nonphysician serv c a hosp

GG Payment screen mam + diagmam

GH Diag mammo to screening mamo

GJ Opt out provider of er srvc

GK Actual item/service ordered

GL Upgraded item, no charge

GM Multiple transports

GN Op speech language service

GO Op occupational therapy serv

GP Op pt services

GQ Telehealth store and forward

GR Service by va resident

GS Epo/darbepoietin reduced 25%

GT Interactivetelecommunication

GU Liability waiver rout notice

GV Attending phys not hospice

GW Service unrelated to term co

GX Voluntary liability notice

GY Statutorily excluded

GZ Not reasonable and necessary

Date	Action	Notes
2002-01-01	Added	Code added 1/1/2002