Office E/M (99213) vs Facility Visit (G0463)
99213 is a professional office E/M billed under the MPFS. G0463 is a hospital outpatient clinic visit billed under OPPS by the facility. Site of service determines which applies.
Last reviewed May 24, 2026
Side by side
CPT 99213 (office E/M)
Professional component of an established-patient office or outpatient E/M. Billed by the physician under the Medicare Physician Fee Schedule.
CPT 99213- Place of service 11 (office).
- MPFS pricing applies.
HCPCS G0463 (hospital outpatient clinic visit)
Hospital outpatient clinic visit for assessment and management of a patient, billed by the facility under the Outpatient Prospective Payment System (OPPS).
HCPCS G0463- Replaced the five-level facility E/M codes in 2014.
- Billed on the UB-04 by the facility; the physician still bills a 992xx code professionally.
- Place of service 19 or 22 (provider-based or on-campus outpatient hospital).
When to use CPT 99213 (office E/M)
- Visit at a physician-owned office (POS 11). Bill 992xx professionally; no facility claim.
When to use HCPCS G0463 (hospital outpatient clinic visit)
- Visit at a hospital-owned outpatient clinic. Facility bills G0463 on the UB-04; the physician separately bills the 992xx professional component.
Common mistakes
- Billing G0463 from a physician office (it is a facility-only code).
- Missing the facility-fee disclosure to the patient when the clinic is provider-based.
- Wrong place of service code on the professional claim — POS 22 vs POS 11 changes the MPFS payment under the site-of-service differential.
Sources
- CMS — Hospital Outpatient PPS (OPPS)https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient
- CMS — G0463 (2014 OPPS Final Rule)https://www.federalregister.gov/documents/2013/12/10/2013-28737/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment
Related
Confirm site-of-service billing in Ask D3
Open ask d3 →D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
This comparison is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at CMS, HHS, OCR, eCFR, NIST, and the relevant payer or state regulator. Last reviewed May 24, 2026.