MS-DRG 005 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 005 by major payers:
$115,538.75
$133,848.56
$167,171.90
$175,083.14
| 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 005 | ||||||
United | 005 | $133554.12 | 1598835308 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH DEPAUL HOSPITAL - ST. LOUIS | 431343281 - SSM HEALTH CARE ST LOUIS | MO | General Acute Care Hospital (282N00000X) |
United | 005 | $9314.00 | 1326046467 - THE BROOKLYN HOSPITAL CENTER | 111630755 - (NY) THE BROOKLYN HOSPITAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 005 | $127473.32 | 1063414233 - MEMORIAL HOSPITAL, MEMORIAL HEALTHCARE | 381358208 - MEMORIAL HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 005 | $240133.31 | 1144251216 - PALM BEACH GARDENS COMMUNITY HOSPITAL, INC., PALM BEACH GARDENS MEDICAL CENTER | 591223933 | FL | General Acute Care Hospital (282N00000X) |
United | 005 | $137146.35 | 1952900920 - VANDERBILT BEDFORD HOSPITAL, LLC, VANDERBILT BEDFORD HOSPITAL | 853419620 | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 005 | $164937.90 | 1780637629 - MERCY MEDICAL CENTER, INC., MERCY MEDICAL CENTER PSYCHIATRIC UNIT | 341893439 - CLEVELAND CLINIC MERCY HOSPITAL | OH | Psychiatric Hospital Unit (273R00000X) |
United | 005 | $87431.57 | 1407072390 - MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY, MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY - SWING BED | 730725208 | OK | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 005 | $138652.09 | 1174021695 - REHABILITATION HOSPITAL, LLC | 823913174 | TX | Rehabilitation Hospital (283X00000X) |
United | 005 | $199816.42 | 1457771511 - GREENVILLE HEALTH SYSTEM, GHS OB/GYN CLINIC | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 005 | $209633.43 | 1013674266 - PENN STATE HEALTH LANCASTER MEDICAL CENTER | 851620990 - (PA) PENN STATE HEALTH LANCASTER MEDICAL CENTER | PA | General Acute Care Hospital (282N00000X) |
United | 005 | $72132.85 | 1104867167 - FORT HAMILTON HOSPITAL, KETTERING HEALTH HAMILTON | 310536662 - (OH) FORT HAMILTON HOSPITAL | OH | General Acute Care Hospital (282N00000X) |
United | 005 | $49617.89 | 1023018835 - WARDS 3 4 & 10 HOSPITAL SERVICE DISTRICT PARISH OF UNION, REEVES MEMORIAL MEDICAL CENTER | 720685207 | LA | Critical Access Hospital (282NC0060X) |
United | 005 | $207972.12 | 1700978558 - SOUTHWEST VOLUSIA HEALTHCARE CORPORATION, ADVENTHEALTH FISH MEMORIAL | 593149293 - SOUTHWEST VOLUSIA HEALTHCARE CORPORATION | FL | General Acute Care Hospital (282N00000X) |
United | 005 | $79105.04 | 1508859661 - MERCY HOSPITAL JEFFERSON, JEFFERSON MEMORIAL HOSPITAL ASSOCIATION | 430687077 - (MO) MERCY HOSPITAL JEFFERSON | MO | General Acute Care Hospital (282N00000X) |
United | 005 | $125109.14 | 1659375673 - THE CITY HOSPITAL ASSOCIATION, EAST LIVERPOOL CITY HOSPITAL | 340714583 - (OH) CITY HOSPITAL ASSOCIATION | OH | 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 005 vs. Other Pre-MDC Codes
The MS-DRG 005 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 005 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 |
|---|---|---|
| 004-APR-DRG | High | TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE |
| 004-MS-DRG | High | Tracheostomy with MV >96 Hours or Principal Diagnosis Except Face, Mouth and Neck without Major O.R. Procedures |
| 005-MS-DRG | High | Liver Transplant with MCC or Intestinal Transplant |
| 006-APR-DRG | High | PANCREAS TRANSPLANT |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 005 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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