MS-DRG 004 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 004 by major payers:
$145,164.95
$179,532.30
$223,756.19
$224,643.74
| 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 004 | ||||||
United | 004 | $89609.25 | 1861882532 - CLEAR LAKE INSTITUTE FOR REHABILITATION LLC, PAM REHABILITATION HOSPITAL OF CLEAR LAKE | 465646835 | TX | Rehabilitation Hospital (283X00000X) |
United | 004 | $362561.65 | 1700087590 - ALAMEDA HEALTH SYSTEM, HIGHLAND GENERAL HOSPITAL | 943302014 | CA | General Acute Care Hospital (282N00000X) |
United | 004 | $437530.81 | 1053347955 - DELRAY MEDICAL CENTER, INC., DELRAY MEDICAL CENTER | 752922687 | FL | Psychiatric Hospital Unit (273R00000X) |
United | 004 | $437530.81 | 1053347955 - DELRAY MEDICAL CENTER, INC., DELRAY MEDICAL CENTER | 752922687 | FL | Psychiatric Hospital Unit (273R00000X) |
United | 004 | $185131.26 | 1902125529 - VHS WEST SUBURBAN MEDICAL CENTER INC | 611899386 | IL | General Acute Care Hospital (282N00000X) |
United | 004 | $249705.35 | 1700625100 - LEE HEALTH SYSTEM INC | 992646504 | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 004 | $249705.35 | 1700625100 - LEE HEALTH SYSTEM INC | 992646504 | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 004 | $140918.48 | 1356399539 - FRANKLIN PARISH HOSPITAL SERVICE DISTRICT NO1, FRANKLIN MEDICAL CENTER | 720685044 - (LA) FRANKLIN MEDICAL CENTER EMPLOYEE BENEFIT PLAN TRUST | LA | Rural Acute Care Hospital (282NR1301X) |
United | 004 | $255906.00 | 1629027263 - WINCHESTER MEDICAL CENTER, WINCHESTER MEDICAL CENTER | 540505979 - VALLEY HEALTH SYSTEM | VA | Psychiatric Hospital Unit (273R00000X) |
United | 004 | $135342.90 | 1497830806 - DELTA HEALTH SYSTEM, DELTA HEALTH-THE MEDICAL CENTER | 640586958 - (MS) DELTA HEALTH SYSTEM | MS | Psychiatric Hospital Unit (273R00000X) |
United | 004 | $501713.90 | 1437575040 - WESTCHESTER COUNTY HEALTH CARE CORPORATION, MID-HUDSON VALLEY DIVISION OF WESTCHESTER MEDICAL CENTER | 133964321 - (NY) PEO MID-HUDSON VALLEY STAFFCO | NY | Psychiatric Hospital Unit (273R00000X) |
United | 004 | $101045.24 | 1396790325 - THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY, CAROLINAS HEALTHCARE SYSTEM UNION | 560529945 | NC | General Acute Care Hospital (282N00000X) |
United | 004 | $166108.68 | 1336109107 - SENTARA HOSPITALS, SENTARA CAREPLEX HOSPITAL | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 004 | $208926.18 | 1881909323 - JERSEY SHORE MEDICAL CENTER | 340714755 - SUMMA HEALTH SYSTEM | NJ | Children's Hospital (282NC2000X) |
United | 004 | $230658.12 | 1477641892 - ST ELIZABETH MEDICAL CENTER, MOHAWK VALLEY HEALTH SYSTEM INC | 150532245 - (NY) ST ELIZABETH MEDICAL CENTER | NY | 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 004 vs. Other Pre-MDC Codes
The MS-DRG 004 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 004 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 |
|---|---|---|
| 003-APR-DRG | High | Bone Marrow Transplant |
| 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-MS-DRG | High | Tracheostomy with MV >96 Hours or Principal Diagnosis Except Face, Mouth and Neck without Major O.R. Procedures |
| 005-APR-DRG | High | TRACHEOSTOMY W MV 96+ HOURS W/O 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 004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 004 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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