Hospital outpatient
G0463 — Hospital outpatient clinic visit
A flat-rate Medicare code for a clinic visit at a hospital-owned outpatient department. The 'facility fee' you weren't expecting on top of your doctor visit.
- Typical setting: Hospital-owned outpatient clinic
- National avg charge (illustrative): Medicare rate ~$130–$200; commercial multiples can be 2–4x.
- Most-disputed reason: Facility fee charged when patient thought they were going to a normal doctor's office.
What it means
What G0463 actually means
G0463 is the Medicare code for any clinic visit at a hospital outpatient department (HOPD). When a hospital system buys a doctor's practice and converts it to an HOPD, the same physical visit now generates two charges: the physician E/M code (e.g., 99213) and the G0463 facility fee.
Patients are often blindsided by this. The visit feels identical, but the bill is suddenly 2–3x higher because of the facility add-on. Some states require advance disclosure; many do not.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Patient billed G0463 with no advance notice that the location was a hospital outpatient department.
- Commercial insurer pays a multiple of Medicare rates, leading to a $400–$800 facility fee for a 15-minute visit.
- G0463 billed without a corresponding E/M code (it should usually accompany one).
- Telehealth visits incorrectly billed with G0463 (telehealth has its own coding rules).
If you see G0463 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on G0463 often also see these adjacent codes on the same bill.
HCPCS
G0011 — Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes
Hiv prep counsel, md 15-30m
HCPCS
G0012 — Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle
Injection of hiv prep drug
Related BillBusted guides
Plain-English reads if you see G0463 on a bill.
G0463 FAQ
Plain-English answers.
Why am I being charged a facility fee at my doctor's office?
Your doctor's practice is owned by a hospital and is registered as a Hospital Outpatient Department. Federal billing rules let them charge the G0463 facility fee on top of the visit. You can ask to be seen at a non-HOPD location to avoid it in the future.
Is G0463 negotiable?
On a self-pay or charity-care basis, yes. Commercial-insured patients can ask for the facility-fee portion to be waived for hardship reasons. Document the lack of advance disclosure if applicable — that strengthens the request.
Don't pay G0463 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.