G0463 (Hospital Outpatient Clinic Visit)
HCPCS code billed by hospital outpatient departments for clinic visits, replacing the E/M codes when furnished in POS 22.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Primary sources
- 1
- Workspace handoff
- ask d3 →
Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
CMS created G0463 to consolidate hospital outpatient clinic-visit billing. The professional component is still billed by the physician using standard E/M codes with POS 22.
How it shows up in your practice
Provider-based clinic billing pairs G0463 on the facility claim with the physician E/M on the professional claim. Both claims must reflect the same encounter.
Sources
- CMS — Hospital outpatient G0463https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient
Confirm G0463 use in Ask D3
Open ask d3 →Related terms
- BillingFacility FeeA charge billed by a hospital or facility for the institutional resources used in providing a service, separate from the professional fee.
- BillingPlace of Service (POS) CodeTwo-digit code on a CMS-1500 claim identifying where a service was provided.
- BillingProfessional ComponentThe portion of a procedure code (designated by modifier 26) representing the physician's interpretation or supervision, separate from the technical component.
- CodingE/M CodingEvaluation and Management codes (99202-99499) used to bill office, hospital, and other professional visits.
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.
Related across the archive
- GlossaryFacility FeeA charge billed by a hospital or facility for the institutional resources used in providing a service, separate from the professional fee.
- GlossaryPlace of Service (POS) CodeTwo-digit code on a CMS-1500 claim identifying where a service was provided.
- GlossaryProfessional ComponentThe portion of a procedure code (designated by modifier 26) representing the physician's interpretation or supervision, separate from the technical component.
- GlossaryE/M CodingEvaluation and Management codes (99202-99499) used to bill office, hospital, and other professional visits.
- BillingAWV + Problem Visit Same Day: How to Bill CorrectlyYes, you can bill AWV and a problem visit the same day. Here's how to do it correctly with modifier -25.
- BillingPlace of Service Codes: Which One to Use and Why It Changes Your ReimbursementPOS 11 vs 21 vs 02 vs 10. How the two-digit code on your claim determines whether you get office or facility rates.
- BillingUB-04 Billing: Bill Types, Revenue Codes, and Occurrence Codes ExplainedBill type 111 vs 131, revenue code 0250, occurrence span code 70. Every UB-04 field explained in plain English.
- Glossary340B Drug PricingHRSA-administered drug-discount program that lets eligible safety-net providers buy outpatient drugs at reduced prices.
This glossary entry 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 HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.