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Denied But Heard

Denied But Heard Hospital facility fee for a doctor’s visit? What to do

A hospital bill for a doctor’s visit? That’s a facility fee.

When a hospital owns the practice, it can bill an ordinary visit as hospital outpatient care and add a facility fee on top of the doctor’s bill, so you get two bills for one visit. Ask before you book whether there will be a facility fee and whether another location doesn’t charge one. If you get one, ask the billing office for an itemized bill and any notice you were given, ask them to remove it, check your state’s rules, and ask about financial assistance.

Updated October 25, 2026. General information, not legal advice. Your policy, plan documents and state rules control.

Billed as a hospital when you never went to one.

You see the same doctor, in the same office, for the same kind of visit. Then a second bill arrives, from a hospital. When a hospital owns the practice, it can bill the visit as hospital outpatient care and add a “facility fee” on top of the doctor’s bill. The care doesn’t change. The price does.

  1. Know how it works

    In a doctor’s own office there is one bill, and it covers the office. When the practice counts as part of a hospital, often called “hospital-based” or “provider-based,” there are two: a smaller one from the doctor, and a separate facility charge from the hospital. Medicare’s advisers gave a real example: for the same epidural injection in 2023, Medicare’s total payment was about $256 in an office and about $741 in a hospital outpatient department ($97 for the doctor plus $644 for the hospital). Your share usually goes up with it, because your deductible, copay or coinsurance applies to the hospital’s charge too.

  2. Ask before you book

    When you schedule, ask: “Is this practice owned by a hospital? Will I get a bill from the hospital, a facility fee? About how much? Can I be seen at a location that doesn’t charge one?” If you have to go there, ask your insurer what you’ll owe for a hospital outpatient visit compared with an office visit. No insurance, or paying yourself? Ask for a good-faith estimate, and ask the hospital for its own estimate too, since the doctor’s may not include the hospital’s charge.

  3. Spot it on the bill

    Signs you were charged a facility fee:

    • Two bills for one visit, one from the doctor and one from a hospital, or two lines on your Explanation of Benefits.
    • A hospital name on the bill for a place you thought was a doctor’s office.
    • On an itemized bill: the code G0463 (a hospital clinic visit), or a “clinic” or “treatment room” charge.
    • On your Explanation of Benefits or claim details: place of service 19 or 22 (hospital outpatient) instead of 11 (office).
    • On Medicare: a separate hospital copayment for an outpatient visit, on top of the 20% you pay for the doctor.

  4. Push back, in this order

    • Ask the hospital’s billing office for an itemized bill and any facility fee notice you were given. Ask whether the fee can be removed or the visit rebilled as an office visit. It’s a request, not a right, but some offices agree.
    • Check your state’s rules below. In some states the hospital can’t charge the fee at all for certain care, or can’t collect it if you weren’t told first.
    • Appeal to your insurer if it applied a higher hospital cost-share than you expected, and ask it to explain the charge in writing.
    • Ask for financial assistance. Nonprofit hospitals must have a written financial assistance policy, and people who qualify can’t be charged more than the hospital generally bills insured patients for emergency or medically necessary care.
    • Uninsured or self-pay? If the bill from one provider or facility is at least $400 more than its good-faith estimate, you can ask for federal dispute resolution within 120 days of the bill. The fee is $25, and the bill can’t go to collections while the dispute is open.
    • Complain to the state. Your state attorney general’s consumer or health unit, or the agency named in your state’s facility fee law. Keep copies of everything.
    A letter to the billing office you can copy

    Re: Account [number], visit on [date] at [location]

    I received a facility fee of $[amount] for this visit. [Only if true: I was seen at what I understood to be a doctor’s office, and I was not told before the visit that a hospital facility fee would apply.]

    Please send me: (1) an itemized bill with the codes for this charge; (2) a copy of any facility fee notice you say I was given, and when; and (3) your financial assistance policy and application.

    I ask that you remove the facility fee or rebill the visit as an office visit. [If your state limits facility fees, add: “I believe this fee is not allowed under (your state’s law).”] Please put any collection activity on hold while you review this, and reply in writing.

    [Your name, address, phone]

The numbers

  • Up to 13.5 times the price. For employer-insured patients in 2022, hospital outpatient prices ran 1.27 to 13.5 times doctor’s-office prices for 57 services that can be done safely in an office. Basic imaging without contrast averaged $227 at a hospital outpatient department and $61 in an office. (Health Care Cost Institute, 2025.)
  • $51 more for an ordinary office visit when Medicare paid for it at a hospital outpatient department rather than an office, in 2013. Over the same years, the number of doctors working for hospitals nearly doubled. (GAO, 2015.)
  • About $7.5 billion in one year (2021): $6.0 billion in Medicare spending and $1.5 billion in patients’ cost-sharing, by Medicare’s advisers’ estimate, if Medicare had paid the lower office or surgery-center rate for 66 groups of services. (MedPAC, 2023.)
  • Maryland, March 2026: the state Attorney General announced a settlement with LifeBridge Health for $1,985,198.90 in restitution to patients, over allegations that patients weren’t adequately told about outpatient facility fees charged before July 1, 2021. LifeBridge denied the allegations.

In Maryland? If a hospital will charge an outpatient facility fee (emergency room charges aren’t included), it must tell you about the fee when you book: an estimate, that you may pay more than at a location without one, and how to complain. You sign an acknowledgment at the visit. If you didn’t get that notice, the law says the hospital “may not charge, bill, or attempt to collect” the fee. Complain to the hospital first, then the Health Services Cost Review Commission (HSCRC); the Attorney General’s Health Education and Advocacy Unit can help, at 1-877-261-8807.

What’s changing

  • Medicare already pays a lower, office-like rate for clinic visits (since 2019) and, since 2026, drug administration at many off-campus hospital clinics. For 2027 it has proposed the same for imaging without contrast. That proposal isn’t final yet.
  • Congress passed a law in February 2026 that requires each off-campus hospital clinic to bill Medicare under its own ID starting in 2028, so these sites can be tracked. It covers Medicare only.
  • Price tags: the hospital price transparency rule counts facility fees as items hospitals must post prices for. A Senate bill that would make facility fees and advance estimates clearer, the Patients Deserve Price Tags Act, passed a Senate committee in July 2026 and is waiting for a vote by the full Senate.
What you pay for outpatient hospital care (Medicare.gov) (opens in a new tab) Dispute a bill over your good-faith estimate (CMS) (opens in a new tab) Nonprofit hospital financial assistance policies (IRS) (opens in a new tab) Maryland health billing complaints (Attorney General) (opens in a new tab) Maryland hospital billing help (HSCRC) (opens in a new tab) Aligning payment across settings, June 2023 (MedPAC, PDF) (opens in a new tab) Hospital ownership and Medicare spending, GAO-16-189 (GAO) (opens in a new tab)

What your state says

States are moving faster than Congress. These are the main protections we confirmed in each state’s own law. Other states have smaller rules, and new laws pass every year, so ask your attorney general or insurance department about yours.

  • Colorado: no facility fee charged to you for preventive care your insurance doesn’t cover; notice when you book and at the visit; off-campus sites need their own billing ID.
  • Connecticut: no facility fee for routine visits at off-campus sites, or for most routine visits on campus outside the emergency department (some specialty visits, such as oncology and wound care, are excepted); written notice and signs.
  • Indiana: large nonprofit hospital systems must bill office-type care away from the main hospital as office care, not hospital care.
  • Maine: under HMO plans, a practitioner’s services in an office setting must be billed as office care.
  • Maryland: notice at booking for hospital outpatient facility fees, and no notice, no fee (see above).
  • Massachusetts: when you book, providers must tell you about facility fees, including the amount.
  • Minnesota: notice before non-emergency care, including telehealth.
  • New Mexico: starting January 1, 2027, no facility fee charged to you for preventive care, vaccines or telehealth (some rural hospitals are exempt).
  • New York: no facility fee for preventive services, and no facility fee your insurance won’t cover unless you got written notice in advance.
  • Ohio: doctors and other licensed professionals can’t charge a facility fee for telehealth; starting January 1, 2028, no facility fee for primary care at physician practices a hospital bought after January 1, 2010.
  • Washington: under state-regulated health plans, no facility fee for telehealth when you’re at home or for audio-only hospital visits (and none for uninsured patients on audio-only calls); notice requirements.
  • Florida, Illinois and Louisiana: disclosure or notice rules that tell you a facility fee may apply.

Each state’s law has exceptions, covered services and dates of its own. If yours is listed, the agency that enforces it can tell you whether it applies to your bill.

Sources, checked October 25, 2026: Medicare.gov and CMS (outpatient costs, place-of-service codes, the 2026 and proposed 2027 outpatient payment rules, hospital price transparency, good-faith estimates and bill disputes under 45 CFR 149.610 and 149.620); the IRS (section 501(r)); MedPAC’s June 2023 report; GAO-16-189; the Health Care Cost Institute’s August 2025 report on site-neutral services; the Consolidated Appropriations Act, 2026, section 6225; Maryland Health-General §19-349.2 (2020 Ch. 365 and 366; 2024 Ch. 142), the HSCRC model notice and the Maryland Attorney General’s March 5, 2026 announcement; and each listed state’s statute or bill text. General information, not legal advice. Your plan documents, bill and state rules control.

Quick answers

What is a hospital facility fee?

A separate charge from a hospital for the use of its facility, added when a visit is billed as hospital outpatient care. It can appear even when you were seen at what looks like a doctor’s office, if a hospital owns the practice.

How do I know if I was charged a facility fee?

Look for two bills for one visit, one from the doctor and one from a hospital, a hospital name on the bill for an office visit, or code G0463 (a hospital clinic visit) on an itemized bill. Place of service 19 or 22 means hospital outpatient; 11 means office.

Can I get a facility fee removed?

Ask the hospital’s billing office in writing to remove it or rebill the visit as an office visit, especially if no one told you about it. Some states ban facility fees for certain care or bar collecting them without advance notice. Nonprofit hospitals must also have a financial assistance policy.

What does Maryland law say about facility fees?

If a hospital will charge an outpatient facility fee (emergency room charges aren’t included), it must tell you about the fee when you book, including an estimate. If you didn’t get that notice, the law says the hospital may not charge, bill or attempt to collect the fee. The Attorney General’s Health Education and Advocacy Unit takes complaints at 1-877-261-8807.

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