MS-DRG 003 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 003 by major payers:
$218,575.22
$263,919.52
$339,369.74
$338,157.12
| 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 003 | ||||||
United | 003 | $1000.00 | 1942501507 - FREEDOM HOSPITAL OF MAGNOLIA LLC, BEACHAM MEMORIAL HOSPITAL | 811097331 | MS | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 003 | $477110.28 | 1710353339 - SMSJ TUCSON HOLDINGS LLC, ST. MARYS HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 003 | $450577.96 | 1134151343 - UNITED HEALTH SERVICES HOSPITALS, INC. | 161165049 - (NY) UNITED HEALTH SERVICES HOSPITALS INC | NY | General Acute Care Hospital (282N00000X) |
United | 003 | $295370.31 | 1053496893 - DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC, MEMORIAL BEHAVIORAL HEALTH UNIT - GERO | 611739000 | PA | Psychiatric Hospital Unit (273R00000X) |
United | 003 | $1000.00 | 1942501507 - FREEDOM HOSPITAL OF MAGNOLIA LLC, BEACHAM MEMORIAL HOSPITAL | 811097331 | MS | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 003 | $342007.00 | 1790739977 - SAINT ANTHONY MEDICAL CENTER, OSF SAINT ANTHONY MEDICAL CENTER | 362167864 | IL | General Acute Care Hospital (282N00000X) |
United | 003 | $144533.37 | 1184891343 - RIVERSIDE MEDICAL CENTER | 362414944 - (IL) RIVERSIDE MEDICAL CENTER | IL | General Acute Care Hospital (282N00000X) |
United | 003 | $285322.87 | 1821019571 - FLORIDA HOSPITAL WATERMAN INC, ADVENTHEALTH WATERMAN | 593140669 - (FL) FLORIDA HOSPITAL WATERMAN INC | FL | General Acute Care Hospital (282N00000X) |
United | 003 | $270466.78 | 1093087157 - PRIME HEALTHCARE SERVICES ROXBOROUGH LLC, ROXBOROUGH MEMORIAL HOSPITAL | 454246163 - (PA) PRIME HEALTHCARE SERVICES ROXBOROUGH, LLC | PA | Psychiatric Hospital Unit (273R00000X) |
United | 003 | $481739.50 | 1477531580 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 003 | $2000.00 | 1902469653 - CLHG-DEQUINCY, LLC | 364911029 - (LA) CLHGDEQUINCY LLC | LA | Critical Access Hospital (282NC0060X) |
United | 003 | $412867.62 | 1295106870 - ST. ANTHONYS HOSPITAL, INC., ST ANTHONYS HOSPITAL | 592043026 - (FL) ST ANTHONYS HOSPITAL INC | FL | Psychiatric Hospital Unit (273R00000X) |
United | 003 | $554649.81 | 1174615330 - EMANUEL MEDICAL CENTER, INC. | 752918774 | CA | General Acute Care Hospital (282N00000X) |
United | 003 | $466801.68 | 1982863080 - MOUNT SINAI SERVICES | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | General Acute Care Hospital (282N00000X) |
United | 003 | $277163.90 | 1669409314 - NORTHFIELD HOSPITAL | 416007241 | MN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
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 003 vs. Other Pre-MDC Codes
The MS-DRG 003 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 003 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 |
|---|---|---|
| 002-APR-DRG | High | HEART &/OR LUNG TRANSPLANT |
| 002-MS-DRG | High | Heart Transplant or Implant of Heart Assist System without MCC |
| 003-MS-DRG | High | ECMO or Tracheostomy with MV >96 Hours or Principal Diagnosis Except Face, Mouth and Neck with Major O.R. Procedures |
| 004-APR-DRG | High | TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 003. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 003 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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