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 | $478720.25 | 1720056138 - JEFFERSON REGIONAL MEDICAL CENTER, JEFFERSON HOSPITAL COUNSELING SERVICES | 251260215 - (PA) HIGHMARK HEALTH | PA | Psychiatric Hospital Unit (273R00000X) |
United | 001 | $79120.00 | 1467560599 - DIGNITY COMMUNITY CARE, METHODIST HOSPITAL OF SACRAMENTO | 721561131 | CA | 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 | $402197.40 | 1396791414 - LONG BEACH MEMORIAL MEDICAL, MEMORIAL REHABILITATION HOSPITAL | 953527031 - (CA) LONG BEACH MEMORIAL MEDICAL CENTER | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 001 | $401673.00 | 1154504892 - ASCENSION BORGESS HOSPITAL, ASCENSION BORGESS - PIPP HOSPITAL | 381360526 - (MI) ASCENSION BORGESS HOSPITAL | MI | Long Term Care Hospital (282E00000X) |
United | 001 | $495508.56 | 1477551489 - ELKHART GENERAL HOSPITAL, INC. | 350877574 - ELKHART GENERAL HOSPITAL INC | IN | General Acute Care Hospital (282N00000X) |
United | 001 | $384556.21 | 1942241799 - SAINT LUKE'S NORTH HOSPITAL, SAINT LUKE'S NORLAND HOSPITAL-SMITHVILLE | 440565393 - (MO) SAINT LUKES NORTH HOSPITAL | MO | General Acute Care Hospital (282N00000X) |
United | 001 | $82653.00 | 1639274764 - UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER, UCSF MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 001 | $305948.12 | 1871665380 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH ST JOSEPH HOSPITAL - LAKE SAINT LOUIS | 431343281 - SSM HEALTH CARE ST LOUIS | MO | General Acute Care Hospital (282N00000X) |
United | 001 | $510803.93 | 1811929151 - SAINT FRANCIS HOSPITAL, ST. FRANCIS HOSPITAL-BARTLETT | 752804737 - (TN) SAINT FRANCIS HOSPITAL | TN | General Acute Care Hospital (282N00000X) |
United | 001 | $520212.15 | 1336173269 - PROVIDENCE HEALTH SYSTEM, PROVIDENCE SAINT JOSEPH MEDICAL CENTER | 951675600 - (CA) PROVIDENCE HEALTH SYSTEMS SO. CA SAN FERNANDO VALLEY SERVICE AREA | CA | General Acute Care Hospital (282N00000X) |
United | 001 | $175633.32 | 1760482939 - NEURO INSTITUTE OF AUSTIN LP, TEXAS NEUROREHAB CENTER | 562274069 | TX | Long Term Care Hospital (282E00000X) |
United | 001 | $480861.06 | 1528024718 - COLUMBIA MEMORIAL HOSPITAL | 141338373 - COLUMBIA MEMORIAL HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 001 | $634716.31 | 1326078288 - DELRAY MEDICAL CENTER, INC., DELRAY MEDICAL CENTER | 752922687 | FL | General Acute Care Hospital (282N00000X) |
United | 001 | $249289.45 | 1134222565 - LAFAYETTE SURGICAL HOSPITAL LLC, LAFAYETTE SURGICAL SPECIALTY HOSPITAL | 900021727 - (LA) LAFAYETTE SURGICAL SPECIALTY HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
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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