Madison Sleep Center

Billing issues: be aware that if you go to a Huntsville Hospital Sleep Center doctor that Huntsville Hospital will charge a G0463 bill code on top of the doctor's visit billing. The G0463 "a facilities charge" amounts to $192.50 on top of the sleep doctor charges. My Medicare Advantage insurance is appealing the charges. In the meantime, Wendy in billing, stated that I will continue to receive bills in spite of my appeal. I'm going to have to find a sleep doctor out of the Huntsville Hospital system. The **G0463 medical billing code** is a key player in hospital outpatient billing. Here's a breakdown of what it means and how it's used: ### 🏥 What Is G0463? - **Code Description**: G0463 represents a **hospital outpatient clinic visit** for **evaluation and management (E/M)** services. - **Purpose**: It covers the **facility fee**—not the physician’s professional services. That means it reimburses the hospital for resources like nursing staff, clinic space, equipment, and overhead costs. ### 📌 Who Can Use It? - **Hospitals only**: This code is **exclusive to hospital outpatient departments**. - **Not for private practices**: Independent clinics or physician-owned offices **cannot bill** G0463. ### 📅 When to Use It - Use G0463 when: - A patient is seen in a **hospital outpatient clinic**. - The visit includes a **face-to-face E/M component**. - Don’t use it if: - The visit occurs in a **physician’s office**. - There’s **no direct patient interaction**. - The patient is in an **inpatient setting**. ### 💡 Why It Matters - **Reimbursement**: Medicare reimburses G0463 claims based on the **Ambulatory Payment Classification (APC)** system, which reflects the resources used during the visit. - **Compliance**: Misuse can lead to **claim denials or audits**, so accurate documentation and coding are essential. If you're navigating hospital billing or just curious about how facilities get reimbursed for outpatient care, G0463 is one of the foundational codes to understand. Want help comparing it to other E/M codes or exploring billing strategies? I’ve got you covered.

Professional, caring staff. Very efficient. Clean and comfortable facility.