MS-DRG 007 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 007 by major payers:
$118,130.84
$163,568.37
$204,326.74
$214,824.54
| 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 007 | ||||||
United | 007 | $252397.73 | 1386649804 - CENTRAL SUFFOLK HOSPITAL, PECONIC BAY MEDICAL CENTER | 111661359 - (NY) CENTRAL SUFFOLK HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 007 | $161530.37 | 1114021292 - HURLEY MEDICAL CENTER | 386005601 | MI | Psychiatric Hospital Unit (273R00000X) |
United | 007 | $171815.51 | 1568463289 - HIGH POINT REGIONAL HEALTH, HIGH POINT REGIONAL REHAB | 560532309 - (NC) HIGH POINT REGIONAL HEALTH | NC | Rehabilitation Hospital Unit (273Y00000X) |
United | 007 | $129943.07 | 1972503464 - KING'S DAUGHTERS MEDICAL CENTER | 640333594 - KINGS DAUGHTERS MEDICAL CENTER | MS | General Acute Care Hospital (282N00000X) |
United | 007 | $249208.95 | 1083781892 - ST. VINCENT HOSPITAL AND HEALTH CARE CENTER, INC., TCU SNF | 743107055 - (IN) ST VINCENT CARMEL HOSPITAL INC | IN | General Acute Care Hospital (282N00000X) |
United | 007 | $483545.59 | 1578587986 - YORK HOSPITAL, WELLSPAN YORK HOSPITAL INPATIENT PSYCH UNIT | 231352222 - YORK HOSPITAL | PA | Psychiatric Hospital Unit (273R00000X) |
United | 007 | $191202.93 | 1225130412 - MUNSTER MEDICAL RESEARCH FOUNDATION INC, COMMUNITY HOSPITAL | 351107009 - (IN) MUNSTER MEDICAL RESEARCH FOUNDATION INC | IN | General Acute Care Hospital (282N00000X) |
United | 007 | $101878.00 | 1083790893 - ANTELOPE MEMORIAL HOSPITAL | 470393176 - (NE) ANTELOPE MEMORIAL HOSPITAL | NE | Critical Access Hospital (282NC0060X) |
United | 007 | $338939.34 | 1619938149 - SENTARA HOSPITALS, SENTARA WILLIAMSBURG REGIONAL MEDICAL CENTER | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 007 | $222483.25 | 1669764353 - DUKE UNIVERSITY HOSPITAL | 562070036 - DUKE UNIVERSITY HEALTH SYSTEM INC | NC | General Acute Care Hospital (282N00000X) |
United | 007 | $270953.21 | 1598880940 - HARRIS METHODIST SOUTHWEST | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | General Acute Care Hospital (282N00000X) |
United | 007 | $230847.28 | 1992880058 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 007 | $374787.06 | 1578007514 - DE CRAIG RANCH, LLC, DIGNITY HEALTH-ST. ROSE DOMINICAN NORTH LAS VEGAS CAMPUS | 364827272 - (NV) DE CRAIG RANCH LLC | NV | General Acute Care Hospital (282N00000X) |
United | 007 | $153388.51 | 1194789818 - BAPTIST MEMORIAL HOSPITAL-DESOTO, INC, | 640682111 - (MS) BAPTIST MEMORIAL HOSPITAL-DESOTO INC | MS | General Acute Care Hospital (282N00000X) |
United | 007 | $136843.40 | 1285664177 - MERCY HOSPITALS EAST COMMUNITIES, MERCY HOSPITAL WASHINGTON | 431066883 - (MO) MERCY HOSPITALS EAST COMMUNITIES | MO | 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 007 vs. Other Pre-MDC Codes
The MS-DRG 007 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 007 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 |
|---|---|---|
| 006-APR-DRG | High | PANCREAS TRANSPLANT |
| 006-MS-DRG | High | Liver Transplant without MCC |
| 007-MS-DRG | High | Lung Transplant |
| 008-APR-DRG | High | AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 007. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 007 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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