Facility fees: what they are and when to push back

You went to the same doctor you always see. But this time, you got 2 bills instead of 1. The second one is from a hospital, and it's for a facility fee.

This guide explains what a facility fee on a medical bill is and why it can make a visit cost more. It also covers when to question one. It's part of our guide to how to read a medical bill.

What is a facility fee?

A facility fee is the charge a hospital sends for its part of outpatient care. It covers things like nursing care, supplies, equipment, and the room. The Medicare Payment Advisory Commission (MedPAC), which advises Congress, describes it the same way. The doctor's own work is billed separately.

You'll see facility fees after emergency room visits, outpatient surgery, and scans at a hospital. You may also see one after a routine office visit, if the clinic is part of a hospital.

That second case surprises people most. Our guide to duplicate charges on a medical bill explains why a facility fee and a doctor's fee for the same visit aren't duplicates.

Why this happens

A facility fee usually shows up for 1 of these reasons:

• The clinic is a hospital outpatient department. Many clinics are owned by a hospital and billed as part of it. That's called provider-based billing. The clinic may look like any other doctor's office.
• A hospital bought your doctor's practice. MedPAC reports that as hospitals buy practices, billing often shifts to hospital rates. That can happen even when the office and the care stay the same.
• You got care on a hospital campus. Scans, lab work, infusions, and procedures in a hospital building usually come with a facility fee.
• Your plan treats hospital care differently. Your plan may cover an office visit with a copay but charge a deductible or coinsurance for hospital outpatient care. It depends on your plan.

Why the same visit can cost more

A visit at an independent office usually creates 1 bill. The same visit at a hospital clinic creates 2: the doctor's fee and the hospital's facility fee. You may owe a share of each.

Medicare.gov puts it plainly. You may pay more for care in a hospital outpatient setting than for the same care in an independent doctor's office. With Original Medicare, you usually pay the hospital a copayment for each service. You also pay 20% of the Medicare-approved amount for the doctor's services.

The gap can be large. A 2023 MedPAC report gave an example. Medicare paid 194% more for 1 type of heart ultrasound in a hospital outpatient department than in a freestanding office.

Hospitals say the higher rates help pay for things offices don't have. MedPAC notes those arguments include standby capacity for emergencies and care for people with low incomes. Hospitals also point to higher overhead costs. So a facility fee isn't a sign of a billing error. It's a reason to ask questions before and after your visit.

Say Priya sees her dermatologist for a follow-up every year. This year, a hospital bought the practice. Her plan is in network, she has met her deductible, and she pays 20% coinsurance. These numbers are fictional.

	Last year (independent office)	This year (hospital clinic)
Doctor's fee, allowed amount	$160	$110
Facility fee, allowed amount	None	$240
Total allowed amount	$160	$350
Priya's 20% share	$32	$70

This year, Priya owes $22 on the doctor's bill ($110 × 20%) and $48 on the hospital bill ($240 × 20%). That's $70 in total, or $38 more than last year ($70 − $32).

The doctor's fee went down, because the hospital now covers the office costs. But the facility fee more than made up for it.

Priya finds 2 EOBs for the visit date. Both show her plan's network discount. Her bills match her EOBs, so they're likely correct. Before her next visit, she asks whether the doctor also sees patients at a location that doesn't charge a facility fee.

How Medicare pays by site of service

Medicare has started to narrow the gap for some care. A 2015 federal law, section 603 of the Bipartisan Budget Act, changed how Medicare pays certain off-campus hospital clinics. Those are clinics more than 250 yards from the main hospital campus.

As of September 2026, here's how it works:

• Off-campus clinics that started billing on or after November 2, 2015 get a lower, doctor's-office-style rate for most services.
• Older off-campus clinics get that lower rate for basic clinic visits. Since January 1, 2026, it also applies to drug infusions and injections there.
• Clinics on the main campus still get the full hospital rate.

CMS estimated the 2026 change alone would save people with Medicare $70 million in coinsurance. Your share is usually 20% of the Medicare-approved amount, so a lower rate means a lower bill for you. CMS has proposed adding some imaging for 2027.

Private health plans set their own rules, and they don't have to follow Medicare's. Ask your plan how it pays for care at a hospital clinic.

Are facility fees allowed?

In general, yes. Hospitals are allowed to bill for their part of outpatient care.

Some states have passed laws that limit facility fees for certain visits. Others require clinics to tell you about the fee ahead of time. A 2023 Georgetown University review found that states are taking more of these steps. Your state insurance department can tell you which rules apply to you.

How to ask before your visit

It's easier to plan for a facility fee than to question one later. When you book, ask:

• "Is this clinic billed as part of a hospital?"
• "Will I get a separate bill from the hospital for this visit?"
• "What's the usual facility fee for this kind of visit?"
• "Does this doctor see patients at a location that doesn't charge one?"

Then call your plan. Ask how it covers a "hospital outpatient" visit compared with an office visit.

If you have Medicare and visit an off-campus hospital clinic, the hospital must give you a written notice before your care. It must tell you what you may owe the hospital, or give you an estimate. Emergencies are handled differently.

If you don't have insurance or won't use it, you can get a good faith estimate for care scheduled at least 3 business days ahead. CMS says it should include facility fees. Our guide to hospital price transparency lookup shows how to find a hospital's prices.

What to do

If you already have a bill with a facility fee, take these steps before you pay:

1. Find both EOBs. You should have 1 for the doctor and 1 for the hospital, for the same date. If you have Original Medicare, use your Medicare Summary Notice.
2. Compare each bill with its EOB. Your amount due shouldn't be more than your share on the EOB. Our guide to EOB vs. medical bill shows how to compare them.
3. Ask for an itemized bill. It shows each line the hospital billed. Check that every line matches care you got.
4. Ask why the fee applies. Call the hospital's billing office. Ask whether the clinic is a hospital outpatient department and what the fee covers.
5. Say if you weren't told. If no one mentioned the fee, or you have Medicare and got no notice, say so. Ask them to review the charge. They may not remove it, but it's fair to ask.
6. Ask about financial help. A facility fee is a hospital bill. If money is tight, ask whether you qualify for hospital charity care.
7. Put it in writing. If a call doesn't settle it, see how to dispute a medical bill. Our dispute letter template gives you the words.

If your bill asks for more than your EOB says, see why your medical bill is higher than your EOB.

When to get help

You can usually sort out a facility fee with 1 or 2 calls. It's worth getting help when:

• The billing office can't tell you why the fee applies.
• Your bill doesn't match your EOB, and calls haven't fixed it.
• You think your state limits facility fees for your kind of visit.

Your insurer's member services team can explain how your plan covered the fee. The number is on your insurance card. Your state insurance department or consumer assistance program can explain state rules.

If you have Medicare, call 1-800-MEDICARE (1-800-633-4227). Your State Health Insurance Assistance Program (SHIP) offers free counseling, too. A medical bill advocate can make the calls for you.