HCPCS G0463
Hospital outpatient clinic visit (facility fee)
The hospital's charge for a visit to a clinic it owns, billed alongside the doctor's own visit code. It exists because Medicare pays hospital-owned clinics a facility fee that independent practices do not get. Many commercial insurers follow the same structure, which is why a doctor's visit can double in price after the practice is bought by a hospital.
Where this line goes wrong
You should have been told
Hospital-owned clinics are expected to notify patients that a facility fee may apply. If you were not told and the clinic is off the hospital campus, ask the hospital for its notice policy and ask for the fee to be reviewed.
Off-campus clinics
Medicare pays a reduced facility rate at many off-campus clinics, and several states restrict or require disclosure of facility fees. Check whether your state has a rule.
Telehealth
A facility fee for a video visit is a question worth asking; the rules for it are narrower.
Check it, then ask
- 1
Ask the hospital whether the clinic is on or off campus and whether a facility fee notice was given.
- 2
Ask your insurer whether it pays facility fees for clinic visits and how it processed this one.
- 3
If self-pay, ask for the cash price for the facility fee or for it to be waived.
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People also ask
Why is there a hospital charge for a visit to my doctor's office?
Because the office is now part of a hospital, and the hospital bills a facility fee for the room. The doctor's charge is the same as before; the hospital's is new.
Can I refuse to pay the facility fee?
You can dispute it, particularly if no notice was given or your state limits the fee. Whether it is owed depends on your plan's contract and state law.
Sources
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.