Physician office: nonfacility rate, overhead inside the payment
In a physician office, Medicare pays the Physician Fee Schedule nonfacility amount. Practice expense - rent, staff, equipment - is inside that payment. There is no separate facility bill.
Confirm your price in writing before service. Ask whether the quote is facility-only or all-in.
- Setting
- In-office ultrasound, echocardiography, X-ray, and some endoscopy performed in office procedure rooms
- Payment system
- Physician Fee Schedule nonfacility payment (higher practice-expense component than facility rate)
- Facility fee
- No separate facility fee - office overhead is inside the nonfacility PFS rate
The nonfacility amount is higher than the facility professional amount for the same code, because the office bears the overhead. For upper endoscopy (CPT 43235) the verified CY2026 anchors are nonfacility $319.52 and facility professional $114.85. The facility amount looks lower only because the hospital or ASC bills its own facility fee on top of it.
Offices commonly perform ultrasound, echocardiography, X-ray, and selected endoscopy in office procedure rooms. The cash quote should be a single global amount when the office provides both the technical and professional portions. Ask whether an outside radiologist or cardiologist will bill the interpretation separately.
If your clinician offers the same study in an office and in a hospital department, ask for the all-in cash price in each setting for the same CPT code. Confirm the chosen price in writing before service.
Office-performed codes and the nonfacility rate
Codes on this site that are commonly performed in a physician office, with the nonfacility or global anchor an office bills and, where one exists, the lower facility professional anchor for comparison.
| Procedure | CPT | Office (nonfacility or global) anchor | Facility professional anchor |
|---|---|---|---|
| Colonoscopy | 45378 | $378.46 nonfacility | $172.49 |
| Upper Endoscopy (EGD) | 43235 | $319.52 nonfacility | $114.85 |
| X-Ray Chest | 71046 | $32.64 global | same as global |
| Echocardiogram | 93306 | $193.43 global | same as global |
| Ultrasound Transvaginal | 76830 | $115.68 global | same as global |
| Ultrasound Thyroid and Neck | 76536 | $106.36 global | same as global |
| X-Ray Lumbar Spine | 72100 | $39.73 global | same as global |
| Echocardiogram Limited | 93308 | $99.23 global | same as global |
| Colonoscopy With Biopsy | 45380 | $477.34 nonfacility | $185.64 |
| Upper Endoscopy (EGD) With Biopsy | 43239 | $413.41 nonfacility | $128.48 |
| Carpal Tunnel Release | 64721 | $495.26 nonfacility | $437.89 |
| Physical Therapy Evaluation | 97161 | $96.48 nonfacility | $96.48 |
| Cardiovascular Stress Test | 93015 | $72.73 nonfacility | $72.73 |
Medicare anchors verified 2026-10-18: fee schedule amounts for Michigan Locality 01, hospital amounts national unadjusted. Not cash prices. The general explanation of facility fees and the four questions that work in any setting are on the facility types overview.
Reading an office quote
In an office the nonfacility amount is designed to cover the room and staff, so a single office figure can be complete. The two things to check are outside readers, such as a cardiologist or radiologist who interprets a study done in the office, and lab or pathology work sent elsewhere.
A practice owned by a hospital may bill office visits and procedures as hospital outpatient services, which adds a facility charge. Ask whether the practice bills under the physician fee schedule or as a hospital department.
Questions for this setting
- Does this practice bill as a physician office or as a hospital outpatient department?
- Will an outside physician read the study and bill separately?
- Is lab or pathology work sent to an outside lab that bills me?
- Is the quoted figure the complete price for this code in this office?