Dispute Inflated ER Hospital Facility Fees

Step-by-Step Checklist

1. Demand an Itemized UB-04 Form

   Request the official hospital claim form showing Revenue Codes (typically Revenue Code 0450) and HCPCS/CPT Level codes (99281 through 99285).

2. Audit the Severity Level Coding

   Hospitals often improperly upcode routine visits to Level 4 (99284) or Level 5 (99285) without meeting the clinical documentation requirements for high-complexity medical decision-making.

3. Send a Facility Fee Dispute & Fee-Waiver Demand

   Demand a downward code adjustment to Level 1 or 2, or request complete fee waiver under hospital charity care policies.

Legal Grounds

• Improper upcoding of facility fees violates False Claims and state deceptive billing practices acts
• Federal Hospital Price Transparency Rule mandates public disclosure of standard charges

Sample Letter Excerpt

I am writing to contest the Emergency Department Facility Fee of $[Amount] coded under CPT 99285 on Account #[Number]. The clinical intervention provided did not involve high-complexity medical decision making. I demand an itemized coding audit and downward fee adjustment.

Frequently Asked Questions

What is an ER facility fee?

A facility fee is an overhead charge billed by the hospital building itself, separate from the doctor's professional fee, to cover equipment, nursing staff, and operating costs.

Can facility fees be negotiated or removed?

Yes. Hospitals frequently reduce or eliminate facility fees when patients formally challenge the complexity level code or request charity care review.