A March 13, 2025, Centers for Medicare and Medicaid Services (CMS) change request (CR 13882) updates the list of unacceptable principal diagnosis codes under the hospice benefit.

The Claims Processing Manual is also updated to provide guidance on non-reportable principle diagnosis codes and provides clarification of liability for claims denials during a hospice election.

Specifically, the CR discusses the responsibility and the liability related to missing GW, GV, or 07 modifiers for Medicare-certified providers.

CMS states, “It is the responsibility of all Medicare-certified providers to check the Medicare status of each Medicare beneficiary when rendering and billing for services, a claim missing the GW or GV modifier or condition code 07 would be denied as provider liability.”

The effective date of this CR is April 1, 2025. For claims received on or after 4/1/25, unless otherwise specified, the effective date is the date of service.

Any claims submitted with these codes will be returned to the provider with claims edits for non-reportable hospice diagnosis code. Providers will no longer receive edits with reason code 30727 but instead they will receive an IOCE edit.