Wiki G0463 vs E/M

[tboersma]

I am going nuts with G0463. My understanding had been that G0463 was used for Medicare payors for hospital outpatient office visits on the FACILITY side. Am I supposed to code an E/M as a profee also? Any clarification would be amazing! Thank you.

 

[AmandaBriggs]

Hi there. You are correct that G0463 is for the facility side. Here is a link to the CMS guidance on it. It is under B.4. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2845CP.pdf. For pro-fee billing you still use the 99202-99215 codes.

 

[tboersma]

Hi there. You are correct that G0463 is for the facility side. Here is a link to the CMS guidance on it. It is under B.4. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2845CP.pdf. For pro-fee billing you still use the 99202-99215 codes.

Thank you for your response! I am getting an edit from Encoder stating that 99213 and G0463 together are unacceptable. I have added a -26 modifier to see if that releases the edit but it doesn't change.

 

[AmandaBriggs]

The G0463 is typically billed by the facility on an UB-04.

 

[thomas7331]

Yes, G0463 is only valid on a UB-04. 99202-99215 are for the physician on the 1500 form, with place of service 19 or 22. Modifier 26 isn't appropriate here.