Revenue code 0450
Emergency room facility fee
The hospital's own charge for the emergency department visit, separate from the doctor's fee. It covers the room, the nurses, the equipment and the overhead of running an ER at 3am. It is billed at one of five levels that mirror the physician levels (99281 to 99285), and it is usually the single largest line on an ER bill.
Where this line goes wrong
The hospital picks its own level
Unlike the doctor's level, which follows national rules, each hospital writes its own criteria for facility levels. CMS only requires that the criteria exist, relate to hospital resources, and are applied the same way to every patient. You are entitled to ask what those criteria are and which ones your visit met.
Level creep is measurable
The share of ER visits billed at the top two levels has risen steadily in national claims data. A high facility level for a short visit with one problem and one test is the pattern to query.
It is negotiable in a way physician fees often are not
The facility fee is where hospitals have the most discretion: cash prices, prompt-pay discounts and financial assistance all apply to it. If you are uninsured, ask for the hospital's published cash price for the ER level billed.
Check it, then ask
- 1
Ask for the itemized bill and identify the 0450 line and its level (it often shows the CPT code 9928x next to it).
- 2
Ask the hospital for its written ER facility level criteria and which points your visit met.
- 3
If uninsured, ask for the discounted cash price for that level; hospitals have to publish one.
- 4
Check for a second facility-type line (trauma activation, observation) and whether each is supported.
The full walkthrough for this kind of bill: You got an ER bill.
For $49, a mediloop specialist reads your itemized bill and EOB, if available, checks every code against the record and available pricing, flags the lines to dispute, and prepares a step-by-step plan with the exact wording to send. It appears in your account within 24 hours after all required documents arrive.
Get the plan for your billNot sure the bill is worth fighting? Run the free savings calculator first
People also ask
Why am I paying a facility fee and a doctor's fee?
Because the hospital and the physician group bill separately. The doctor's charge pays for the doctor; the facility fee pays for everything else in the room. Both are normal; the thing to check is whether each level is supported.
Is the facility fee covered by insurance?
Usually yes, subject to your ER copay, deductible and coinsurance. If the hospital was out of network for an emergency, federal surprise billing protections limit what you can be asked to pay to your in-network cost sharing.
Sources
- CMS, OPPS questions and answers on emergency department and trauma billing
- Trilliant Health, Changes in coding intensity suggest how upcoding is happening across outpatient settings (May 2025)
- 45 CFR 180, hospital price transparency
- CMS, No Surprises Act, what patients can expect
This page explains a billing code in general terms. It is not a coding, legal or medical opinion about your bill, and the code descriptions are mediloop's own plain-English summaries, not the official CPT descriptors, which are owned by the American Medical Association. Whether a charge was correct depends on the record of your visit and your payer's rules.