MS-DRG 001 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Pre-MDC |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 001 by major payers:
$260,415.89
$328,042.77
$441,713.26
$462,844.80
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for MS-DRG 001 | ||||||
United | 001 | $253350.25 | 1346275856 - BRONSON SOUTH HAVEN HOSPITAL | 381676780 - (MI) BRONSON SOUTH HAVEN HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 001 | $828148.00 | 1902047376 - FLOWER MOUND HOSPITAL PARTNERS, LLC, TEXAS HEALTH PRESBYTERIAN HOSPITAL FLOWER MOUND | 260684968 - (TX) FLOWER MOUND HOSPITAL PARTNERS, LLC DBA TEXAS HEALTH PRESBYTERIAN HOSP | TX | General Acute Care Hospital (282N00000X) |
United | 001 | $82653.00 | 1124396999 - UCSF MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 001 | $82653.00 | 1124396999 - UCSF MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 001 | $764797.50 | 1043462013 - GADSDEN REGIONAL MEDICAL CENTER LLC, GADSDEN REGIONAL MEDICAL CENTER | 631102774 | AL | General Acute Care Hospital (282N00000X) |
United | 001 | $2884.00 | 1013985399 - ST JAMES HOSPITAL | 160743310 - ST JAMES HOSPITAL | NY | Rural Acute Care Hospital (282NR1301X) |
United | 001 | $494189.21 | 1255938510 - ASCENSION WISCONSIN EMERUS MENOMONEE FALLS, LLC, ASCENSION WISCONSIN HOSPITAL - GREENFIELD CAMPUS | 852744492 - ASCENSION WISCONSIN EMERUS MENOMONEE FALLS LLC | WI | General Acute Care Hospital (282N00000X) |
United | 001 | $744600.81 | 1457526154 - SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC, BAPTIST MEDICAL CENTER | 590747311 - SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC | FL | Psychiatric Hospital (283Q00000X) |
United | 001 | $253486.53 | 1982747390 - ENDLESS MOUNTAINS HEALTH SYSTEMS, INC. | 232720289 - (PA) ENDLESS MOUNTAINS HEALTH SYSTEMS INC | PA | Critical Access Hospital (282NC0060X) |
United | 001 | $412074.06 | 1033225172 - MUNSTER MEDICAL RESEARCH FOUNDATION INC, COMMUNITY HOSPITAL | 351107009 - (IN) MUNSTER MEDICAL RESEARCH FOUNDATION INC | IN | Rehabilitation Hospital Unit (273Y00000X) |
United | 001 | $495508.56 | 1477551489 - ELKHART GENERAL HOSPITAL, INC. | 350877574 - ELKHART GENERAL HOSPITAL INC | IN | General Acute Care Hospital (282N00000X) |
United | 001 | $491029.81 | 1639194228 - NASSAU HEALTH CARE CORPORATION, NUMC-DEPARTMENT OF MEDICINE, FPP | 113465690 | NY | General Acute Care Hospital (282N00000X) |
United | 001 | $491029.81 | 1639194228 - NASSAU HEALTH CARE CORPORATION, NUMC-DEPARTMENT OF MEDICINE, FPP | 113465690 | NY | General Acute Care Hospital (282N00000X) |
United | 001 | $445284.50 | 1548232838 - COMMUNITY HEALTH NETWORK, INC.., HOOK REHABILITATION CENTER | 350983617 - COMMUNITY HEALTH NETWORK INC | IN | Rehabilitation Hospital Unit (273Y00000X) |
United | 001 | $482100.43 | 1144234428 - SAINT FRANCIS HOSPITAL AND MEDICAL CENTER | 60646813 - (CT) SAINT FRANCIS HOSPITAL AND MEDICAL CENTER | CT | Psychiatric Hospital Unit (273R00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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MS-DRG 001 vs. Other Pre-MDC Codes
The MS-DRG 001 code is part of the Pre-MDC services . It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The MS-DRG 001 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 001-MS-DRG | High | Heart Transplant or Implant of Heart Assist System with MCC |
| 002-APR-DRG | High | HEART &/OR LUNG TRANSPLANT |
| 002-MS-DRG | High | Heart Transplant or Implant of Heart Assist System without MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 001. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 001 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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