MS-DRG 004 Fee Schedule

Last Verified: March 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

Preview provider-level rates for...

For billing codeMS-DRG 004

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	$3558.00	1376748160 - SHRINERS HOSPITALS FOR CHILDREN	362193608 - SHRINERS HOSPITALS FOR CHILDREN	FL	Children's Hospital (282NC2000X)
United	004	$362561.65	1700087590 - ALAMEDA HEALTH SYSTEM, HIGHLAND GENERAL HOSPITAL	943302014	CA	General Acute Care Hospital (282N00000X)
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	$240549.12	1699065136 - DUKE UNIVERSITY HOSPITAL	562070036 - DUKE UNIVERSITY HEALTH SYSTEM INC	NC	General Acute Care Hospital (282N00000X)
United	004	$166451.40	1174706576 - LUTHERAN MUSCULOSKELETAL CENTER LLC, THE ORTHOPAEDIC HOSPITAL OF LUTHERAN HEALTH NETWORK	261483076 - (IN) LUTHERAN MUSCULOSKELETAL CENTER LLC	IN	General Acute Care Hospital (282N00000X)
United	004	$118484.67	1932213600 - RUSH UNIVERSITY MEDICAL CENTER	362174823 - (IL) RUSH UNIVERSITY MEDICAL CENTER	IL	General Acute Care Hospital (282N00000X)
United	004	$6649.00	1215998323 - UNIVERSITY HOSPITAL, UNIVERSITY OF MEDICINE AND DENTISTRY OF NJ	221775306	NJ	General Acute Care Hospital (282N00000X)
United	004	$246314.15	1215135785 - NASSAU HEALTH CARE CORPORATION, NASSAU UNIVERSITTY MEDICAL CENTER -	113465690	NY	Substance Use Disorder Rehabilitation Hospital Unit (276400000X)
United	004	$221501.87	1710992557 - WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE	272844942	MI	General Acute Care Hospital (282N00000X)
United	004	$152702.90	1013365824 - ST VINCENTS CHILTON LLC, ST VINCENTS CHILTON SWING BEDS	810935368	AL	Medicare Defined Swing Bed Hospital Unit (275N00000X)
United	004	$59258.16	1730253360 - BURGESS HEALTH CENTER	420859940 - BURGESS HEALTH CENTER	IA	Critical Access Hospital (282NC0060X)
United	004	$299694.34	1578648614 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL	474131755	AZ	Psychiatric Hospital Unit (273R00000X)
United	004	$4120.00	1104812684 - JOHNSTON MEMORIAL HOSPITAL, INC	540544705 - JOHNSTON MEMORIAL HOSPITAL INC	VA	General Acute Care Hospital (282N00000X)
United	004	$166290.89	1093712911 - AUBURN COMMUNITY HOSPITAL	150532054 - AUBURN COMMUNITY HOSPITAL	NY	General Acute Care Hospital (282N00000X)
United	004	$168831.25	1073751699 - MERCY TYLER HOSPITAL, TYLER MEMORIAL HOSPITAL	274566015	PA	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 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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