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KMAP BULLETIN: Hospice Attending Physician Services for RHCs and FQHCs Update

Date: 01/17/22

KMAP GENERAL BULLETIN 21270 (PDF)

Effective with dates service on and after January 1, 2022, Rural Health Centers (RHCs) and/or Federally Qualified Health Centers (FQHCs) can bill and receive payment under the RHC/ FQHC Prospective Payment System (PPS) when a designated attending physician employed by or working under contract with the RHC or FQHC furnishes hospice attending physician services.

To receive payment under the RHC and FQHC PPS, the RHC or FQHC must report the GV modifier (attending physician not employed or paid under the arrangement by the patient's hospice provider) when a physician, nurse practitioner (NP), or physician assistant (PA) employed by or working under contract with an RHC or FQHC furnishes hospice attending physician services to a member that has elected hospice.

  • The RHC/FQHC must report the GV modifier on the claim line with the payment code each day a hospice attending physician service is furnished. 
  • If the RHC/FQHC providing hospice attending physician services submits a claim without the GV modifier, the claims will be denied. 
  • If the RHC/FQHC providing hospice attending physician services submits a claim with modifier GV for a non-hospice member, the claim will be denied.

Approved CPT Codes:

  • 99212
  • 99213
  • 99214
  • 99215
  • 99307
  • 99308
  • 99309
  • 99310
  • 99334
  • 99335
  • 99336
  • 99337
  • 99347
  • 99348
  • 99349
  • 99350

Note: The effective date of the policy is January 1, 2022. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.