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See a sample rate comparisonHCPCS G0463 Fee Schedule
HCPCS G0463 is classified under Procedures / Professional Services, in the Miscellaneous Services subgroup.
Hospital outpatient clinic visit for assessment and management of a patient
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Miscellaneous Services |
| Hospital Outpatient Group (APC) | APC 5012 - Clinic Visits and Related Services |
| Add-on Codes | 1585315854Sign up to view all 13 |
| Common Revenue Codes | 05100761Sign up to view all 6 |
| Medicaid Fee Schedule | $101.31 median of the 3 states in the free previewView Medicaid rates for G0463 |
National average reimbursement for HCPCS G0463 by major payers:
$110.36
BCBS / Anthem
$58.50
UnitedHealthcare
$94.61
Aetna
$91.64
Cigna
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HCPCS G0463
5 of 25 sample ratesHigher to lower in this preview
St. Tammany Parish Hospital Service District No 1, St. Tammany Parish Hospital
$379.02Published rateSlidell Memorial Hospital, Md Imaging Slidell
Slidell Memorial Hospital
$265.22Published rateLafayette Surgical Hospital LLC, Lafayette Surgical Specialty Hospital
Lafayette Surgical Specialty Hospital
$196.55Published rateSavoy Medical Management Group, Inc., Savoy Medical Center Hospital Based Physicians
Savoy Medical Management Group Inc
$156.08Published rateSabine Medical Center
$134.39Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G0463 vs. Other Miscellaneous Services Codes
The table lists codes related to G0463. Select one to see its fee schedule.
| Code | Description |
|---|---|
| G0460-HCPCS | 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 | Hospital outpatient clinic visit for assessment and management of a patient |
| G0465-HCPCS | 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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Frequently Asked Questions
What APC is HCPCS G0463 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns HCPCS G0463 to APC 5012 (Clinic Visits and Related Services). An APC groups outpatient services that Medicare pays at the same base rate.
Which add-on codes are billed with HCPCS G0463?
CMS add-on code edits list HCPCS G0463 as a primary code for these add-on codes: including 15853, 15854, 90833, 90836 and 90838.
Which revenue codes are billed with HCPCS G0463?
Hospital price transparency files list HCPCS G0463 under these revenue codes: including 0510, 0761, 0450, 0760 and 0914. A revenue code names the hospital department or charge category for the line; it does not change what the service is.