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See a sample rate comparisonMS-DRG 004 Fee Schedule
Last Verified: October 2026
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.
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
| 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
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MS-DRG 004
5 of 25 sample ratesHigher to lower in this preview
Alameda Health System, Highland General Hospital
$362,561.65Published rateProspect Ccmc, LLC
$218,294.37Published rateLutheran Musculoskeletal Center LLC, The Orthopaedic Hospital Of Lutheran Health Network
Lutheran Musculoskeletal Center LLC
$166,451.40Published rateSt Jude Childrens Research Hospital Inc
$89,609.25Published rateShriners Hospitals For Children
$3,558.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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