Hospital facility fees explained: what they are and how to question one
Why hospital bills include a separate facility fee, how big it is compared with Medicare in real 2026 price files, and when you can push back.
What a facility fee is
When you get care in a hospital or a hospital-owned clinic, you can get two charges for the same visit: a professional fee from the clinician and a facility fee from the hospital for the room, staff, equipment and overhead. Independent doctors' offices usually don't charge one. That's why the same visit can cost more once a practice is bought by a hospital.
How big facility fees are
The ER visit codes 99281–99285 are billed as facility fees. In 2026 hospital price files, the facility list price for a level 3 ER visit (99283) was $1,178–$3,981.01 across four hospitals, against a Medicare OPPS payment of $278.89. For level 5 (99285) it was $3,156–$4,428.08 against $608.43. Across all 797 outpatient prices in our study, the median list price was 8.0x Medicare.
Facility fees on imaging and procedures
Facility fees are built into hospital charges for scans and procedures too. A head CT without contrast (70450) was listed at $1,358–$3,297.40 at the four hospitals. Medicare's 2026 OPPS rate is $106.81. Simple stitches (12001) ranged from $399 to $6,346.39 against $204.98.
When you can question one
Ask whether you were seen in a hospital outpatient department (it shows up as "hospital-based" or "provider-based" billing). Some states require notice before facility fees are charged at off-campus clinics. Ask the hospital for its cash or self-pay price, ask for its financial assistance policy, and check the bill for duplicate visit charges on the same day.
What to ask for
Request an itemized bill with revenue codes and CPT codes. If the facility visit level looks too high for the care you got, ask for a coding review. If you're uninsured, compare the facility charge with the hospital's posted discounted cash price. Those were a median 3.3x Medicare in our study, compared with 8.0x for list prices.
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Why was I charged a facility fee for a doctor's visit?
The clinic is probably owned by a hospital and bills as a hospital outpatient department. You get a professional fee plus a facility fee.
Can I refuse a facility fee?
Usually not after the fact, but you can ask for a coding review, the self-pay price, or financial assistance, and some states limit these fees.
Does Medicare pay facility fees?
Yes. The Medicare rates on this page are 2026 OPPS facility payments, separate from physician fees.
Educational information, not legal advice. Laws and deadlines change, so verify with official sources. More guides: How to dispute a medical bill · How to request an itemized medical bill (free letter template) · No Surprises Act dispute · Medical billing error checklist · Hospital charity care · ER bill too high? What to check and how to fight it · BillRebuttal vs. hiring a medical bill advocate · BillRebuttal vs. Dollar For · CPT 99285 cost · How much do stitches cost at the ER? 2026 hospital price data · How much does a CT scan cost at the hospital? 2026 price file data · Hospital cash price vs list price