Reason Code: PR-B9

Error Description:

Patient is enrolled in a Hospice. 

Avoiding/Correcting This Error

When a Medicare beneficiary, or their authorized representative elects hospice all services related to the patient's terminal condition are handled by the hospice and not billed to Medicare Part B. If the patient requires care unrelated to their terminal condition, a Medicare provider may bill that service to Medicare, and ensure modifier GW is appended to the CPT/HCPCS code being billed. The physician who is the attending physician for the patient's hospice care may bill their claims to Medicare Part B with modifier GV appended to the CPT/HCPCS code being billed