HCPCS G0463 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Procedures / Professional Services • Miscellaneous Services |
| Complexity Level | Low |
National average reimbursement for HCPCS G0463 by major payers:
$110.36
$58.50
$94.61
$91.64
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS G0463 | ||||||
United | G0463 | $325.76 | 1780015396 - STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER | 646008520 | MS | Ambulance (341600000X) |
United | G0463 | $314.23 | 1083041917 - STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER | 646008520 | MS | Psychiatric Hospital (283Q00000X) |
United | G0463 | $314.23 | 1083041917 - STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER | 646008520 | MS | Psychiatric Hospital (283Q00000X) |
United | G0463 | $325.76 | 1780015396 - STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER | 646008520 | MS | Ambulance (341600000X) |
United | G0463 | $194.58 | 1083661409 - LALLIE KEMP MEDICAL CTR, LALLIE KEMP REGIONAL MEDICAL CENTER | 726000749 | LA | Critical Access Hospital (282NC0060X) |
United | G0463 | $144.13 | 1104873710 - CLHG-OAKDALE, LLC, OAKDALE COMMUNITY HOSPITAL | 813465783 - (LA) CLHGOAKDALE LLC | LA | General Acute Care Hospital (282N00000X) |
United | G0463 | $154.63 | 1043392491 - DOCTORS' HOSPITAL OF SLIDELL, LLC, STERLING SURGICAL HOSPITAL | 522363244 - (LA) DOCTORS HOSPITAL OF SLIDELL, LLC | LA | General Acute Care Hospital (282N00000X) |
United | G0463 | $288.41 | 1578568481 - SLIDELL MEMORIAL HOSPITAL, ST TAMMANY PARISH HOSPITAL SERVICE DISTRICT #2 | 726014895 - (LA) SLIDELL MEMORIAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | G0463 | $225.22 | 1619061769 - ANNA JAQUES HOSPITAL | 42104338 - (MA) ANNA JAQUES HOSPITAL | MA | Psychiatric Hospital Unit (273R00000X) |
United | G0463 | $134.39 | 1619057155 - SABINE MEDICAL CENTER | 262074318 | LA | General Acute Care Hospital (282N00000X) |
United | G0463 | $179.57 | 1083903744 - HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST. BERNARD, STATE OF LOUIS, ST. BERNARD PARISH HOSPITAL | 261576974 - (LA) HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST BERNARD STATE OF LOUIS | LA | Rural Acute Care Hospital (282NR1301X) |
United | G0463 | $154.22 | 1043392491 - DOCTORS' HOSPITAL OF SLIDELL, LLC, STERLING SURGICAL HOSPITAL | 522363244 - (LA) DOCTORS HOSPITAL OF SLIDELL, LLC | LA | General Acute Care Hospital (282N00000X) |
United | G0463 | $180.03 | 1083903744 - HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST. BERNARD, STATE OF LOUIS, ST. BERNARD PARISH HOSPITAL | 261576974 - (LA) HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST BERNARD STATE OF LOUIS | LA | Rural Acute Care Hospital (282NR1301X) |
United | G0463 | $210.36 | 1225450588 - PARISH HOSPITAL SERVICE DISTRICT FOR THE PARISH OF ORLEANS, NEW ORLEANS EAST HOSPITAL | 273335876 | LA | General Acute Care Hospital (282N00000X) |
United | G0463 | $158.55 | 1144274127 - PROGRESSIVE ACUTE CARE DAUTERIVE, LLC, DAUTERIVE HOSPITAL | 364756243 - (LA) PROGRESSIVE ACUTE CARE DAUTERIVE LLC | LA | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS G0463 vs. Other Miscellaneous Services Codes
The HCPCS G0463 code is part of the Procedures / Professional Services services used for Miscellaneous Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS G0463 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| G0460-HCPCS | Moderate | Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment |
| G0463-HCPCS | Low | Hospital outpatient clinic visit for assessment and management of a patient |
| G0465-HCPCS | Moderate | Autologous platelet rich plasma (PRP) or other blood-derived product for diabetic chronic wounds/ulcers, using an FDA-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0463. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0463 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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