G0463
Statutory exclusionGlobal n/aHospital outpt clinic visit
Statutory exclusion: Outside the statutory definition of physician services (e.g., lab, ambulance).
2026 Medicare payment
Estimated allowed amounts. Pick a locality or enter a ZIP; toggle modifiers to see how the payment rules change the number; add the add-on codes to price the whole procedure.
| Line | Qty | Non-facility (office) | Facility (hospital/ASC) |
|---|---|---|---|
| G0463 | 1 | $0.00 | $0.00 |
| add-on15853 | 0 | $13.36/ unit | $13.36/ unit |
| add-on15854 | 0 | $17.70/ unit | $17.70/ unit |
| add-on90833 | 0 | $81.50/ unit | $65.80/ unit |
| add-on90836 | 0 | $103.21/ unit | $83.17/ unit |
| add-on90838 | 0 | $136.61/ unit | $110.22/ unit |
| add-on96160 | 0 | $3.01/ unit | $3.01/ unit |
| add-on96161 | 0 | $3.34/ unit | $3.34/ unit |
| add-on99415 | 0 | $23.05/ unit | $23.05/ unit |
| add-on99417 | 0 | $0.00/ unit | $0.00/ unit |
| add-on99459 | 0 | $17.37/ unit | $17.37/ unit |
| add-onG0506 | 0 | $66.47/ unit | $38.41/ unit |
| add-onG2211 | 0 | $17.37/ unit | $14.36/ unit |
| add-onG2212 | 0 | $34.07/ unit | $27.39/ unit |
How these numbers were computed
- status=XThis code is not separately payable under the Physician Fee Schedule (status X) — amounts shown are $0.
RVU breakdown (national)
Relative value units before geographic adjustment. Payment = (work×GPCIw + PE×GPCIpe + MP×GPCImp) × CF
| Row | Work RVU | PE RVU (office) | PE RVU (facility) | MP RVU | Total (office) |
|---|---|---|---|---|---|
| G0463 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 |
Payment policy for G0463
CMS's indicator fields, translated. These control which modifiers are payable and how.
Professional/technical (PC/TC)
pctc=9Not applicable
The professional/technical concept does not apply.
Multiple procedures
mult_surg=9Not applicable
The multiple-procedure concept does not apply.
Bilateral (modifier 50)
bilt_surg=9Not applicable
The bilateral concept does not apply.
Assistant surgeon (80/81/82)
asst_surg=9Not applicable
The assistant-at-surgery concept does not apply.
Co-surgeons (modifier 62)
co_surg=9Not applicable
The co-surgeon concept does not apply.
Team surgery (modifier 66)
team_surg=9Not applicable
The team-surgery concept does not apply.
Source: pfs.data.cms.gov "Indicators for 2026", retrieved 2026-07-16; conversion factors $33.4009 / $33.5675 (QP) per CMS-1832-F. Estimated amounts — not billing or coding advice.