HCPCS code G0463 — Hospital outpt clinic visit.
Status: Active.
Effective Jan 1, 2014.
Source: CMS HCPCS Level II.
G0463
ActiveHospital outpt clinic visit
Hospital outpatient clinic visit for assessment and management of a patient
Category:
Procedures
Section:
G-codes: Procedures / Professional Services
Effective:
Jan 1, 2014
Code type:
alphanumeric
OPPS Status:
J2
— Hospital Part B services paid through a comprehensive APC when billed with primary J1
OPPS APC:
5012
MUE — Medically Unlikely Edits
Maximum units of G0463 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| Outpatient Hospital | 4 |
| Practitioner Services | 0 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NCCI Edits
The following codes cannot be billed together with G0463 without appropriate documentation.
| Column 2 Code | Modifier |
|---|---|
| G0102 | Modifier cannot bypass edit |
| G0117 | Modifier cannot bypass edit |
| G0118 | Modifier cannot bypass edit |
| G0245 | Modifier cannot bypass edit |
| G0246 | Modifier cannot bypass edit |
| G0248 | Modifier may bypass edit |
| G0250 | Modifier may bypass edit |
| G0271 | Modifier cannot bypass edit |
| G0473 | Modifier may bypass edit |
| G2011 | Modifier may bypass edit |
Source: CMS National Correct Coding Initiative (NCCI)
NCCI Edits — Reverse Direction
G0463 cannot be billed together with the following column 1 codes without appropriate documentation.
| Column 1 Code | Modifier |
|---|---|
| C8957 | Modifier may bypass edit |
| C9738 | Modifier may bypass edit |
| C9739 | Modifier may bypass edit |
| C9740 | Modifier may bypass edit |
| C9761 | Modifier may bypass edit |
| C9778 | Modifier may bypass edit |
| C9796 | Modifier may bypass edit |
| C9797 | Modifier may bypass edit |
| C9901 | Modifier may bypass edit |
| G0101 | Modifier may bypass edit |
| G0104 | Modifier may bypass edit |
| G0105 | Modifier may bypass edit |
| G0121 | Modifier may bypass edit |
| G0127 | Modifier may bypass edit |
| G0168 | Modifier may bypass edit |
| G0268 | Modifier may bypass edit |
| G0302 | Modifier may bypass edit |
| G0303 | Modifier may bypass edit |
| G0304 | Modifier may bypass edit |
| G0305 | Modifier may bypass edit |
| G0337 | Modifier cannot bypass edit |
| G0339 | Modifier cannot bypass edit |
| G0340 | Modifier cannot bypass edit |
| G0341 | Modifier may bypass edit |
| G0342 | Modifier may bypass edit |
| G0343 | Modifier may bypass edit |
| G0402 | Modifier may bypass edit |
| G0410 | Modifier may bypass edit |
| G0411 | Modifier may bypass edit |
| G0412 | Modifier may bypass edit |
| G0413 | Modifier may bypass edit |
| G0414 | Modifier may bypass edit |
| G0415 | Modifier may bypass edit |
| G0429 | Modifier may bypass edit |
| G0455 | Modifier may bypass edit |
| G0471 | Modifier may bypass edit |
| G0491 | Modifier may bypass edit |
| G0492 | Modifier may bypass edit |
| G0498 | Modifier may bypass edit |
| G0500 | Modifier may bypass edit |
| M0224 | Modifier may bypass edit |
| P3000 | Modifier may bypass edit |
| P3001 | Modifier may bypass edit |
| Q0091 | Modifier may bypass edit |
| Q2043 | Modifier may bypass edit |
Source: CMS National Correct Coding Initiative (NCCI)