TO:  All Hospitals

A new CMS policy requiring hospital to bill an outpatient hospital clinic visits using a single HCPCS code will be implemented in Alabama on April 1, 2014.

Effective for dates of service April 1, 2014, and thereafter, HCPCS code G0463 (Hospital Outpatient Clinic Visit for Assessment and Management of a Patient) will replace CPT E&M codes 99201-99205 and 99211-99215 for outpatient hospital-based clinic visits. 

For claims with dates of service through March 31, 2014, the hospital will continue to bill the CPT E&M codes 99201 – 99205 and 99211 – 99215 for outpatient hospital-based clinic visits.

For claims with dates of service April 1, 2014, and thereafter the hospital will bill G0463 for outpatient hospital-based clinic visits. 

The reimbursement amount for G0463 is $51.81.

For questions, please contact:  Solomon Williams, Associate Director, Institutional Services at 334-353-3206 or via email at Solomon.williams@medicaid.alabama.gov.