MS-DRG 011 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 011 by major payers:
$57,662.56
$69,583.33
$84,156.35
$86,456.89
| 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 011 | ||||||
United | 011 | $112536.25 | 1801971916 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 011 | $151560.04 | 1700359205 - MEDICAL UNIVERSITY HOSPITAL AUTHORITY, MUSC HEALTH LANCASTER MEDICAL CENTER | 571098556 - (SC) MEDICAL UNIVERSITY HOSPITAL AUTHORITY | SC | General Acute Care Hospital (282N00000X) |
United | 011 | $170041.00 | 1720004450 - NORTH COLORADO MEDICAL CENTER | 841287638 | CO | General Acute Care Hospital (282N00000X) |
United | 011 | $170041.00 | 1720004450 - NORTH COLORADO MEDICAL CENTER | 841287638 | CO | General Acute Care Hospital (282N00000X) |
United | 011 | $61946.23 | 1548376700 - TISHOMINGO HEALTH SERVICES, INC., TISHOMINGO CO HOSPITAL | 640741047 - TISHOMINGO HEALTH SERVICES INC | MS | General Acute Care Hospital (282N00000X) |
United | 011 | $46736.69 | 1770531600 - NORTHWEST COMMUNITY HOSPITAL | 362340313 - NORTHWEST COMMUNITY HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 011 | $110741.89 | 1417202169 - ST VINCENT'S MEDICAL CENTER | 832550272 - (CT) SVMC HOLDINGS INC | CT | General Acute Care Hospital (282N00000X) |
United | 011 | $58324.28 | 1427041516 - INDIANA REGIONAL MEDICAL CENTER | 250965404 - (PA) INDIANA REGIONAL MEDICAL CENTER | PA | Rural Acute Care Hospital (282NR1301X) |
United | 011 | $77705.43 | 1740661305 - SAINT THOMAS DEKALB HOSPITAL, LLC, ASCENSION SAINT THOMAS DEKALB | 474063289 - (TN) SAINT THOMAS DEKALB HOSPITAL LLC | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 011 | $41417.12 | 1790469146 - MERCY HEALTH KINGS MILLS HOSPITAL LLC, MERCY HEALTH - KINGS MILLS HOSPITAL | 844831141 - (OH) MERCY HEALTH KINGS MILLS HOSPITAL LLC | OH | General Acute Care Hospital (282N00000X) |
United | 011 | $49474.69 | 1043213911 - CONDELL MEDICAL CENTER | 262525968 - (IL) ADVOCATE HEALTH CARE NETWORK | IL | General Acute Care Hospital (282N00000X) |
United | 011 | $135933.51 | 1588825848 - BANNER DEL E WEBB MEDICAL CENTER | 900389312 - (AZ) BANNER DEL E WEBB MEDICAL CENTER | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 011 | $59257.76 | 1942750831 - ADVOCATE GOOD SAMARITAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | General Acute Care Hospital (282N00000X) |
United | 011 | $87651.93 | 1164876546 - BBH PBMC, LLC, PRINCETON BAPTIST MEDICAL CENTER | 474775351 | AL | General Acute Care Hospital (282N00000X) |
United | 011 | $132616.51 | 1164529400 - VALLEY BAPTIST MEDICAL CENTER | 452662980 | TX | 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 011 vs. Other Pre-MDC Codes
The MS-DRG 011 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 011 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 |
|---|---|---|
| 010-APR-DRG | Moderate | Head Trauma With Deep Coma |
| 010-MS-DRG | High | Pancreas Transplant |
| 011-MS-DRG | High | Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC |
| 012-APR-DRG | Moderate | Liver Transplant And/Or Intestinal 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 011. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 011 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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