MS-DRG 012 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 012 by major payers:
$45,337.42
$53,138.56
$63,930.71
$65,960.07
| 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 012 | ||||||
United | 012 | $70645.20 | 1396833844 - BAPTIST HEALTH SYSTEM INC, WALKER BAPTIST MEDICAL CENTER | 474790386 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 012 | $91356.57 | 1992880058 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 012 | $70645.20 | 1396833844 - BAPTIST HEALTH SYSTEM INC, WALKER BAPTIST MEDICAL CENTER | 474790386 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 012 | $74100.50 | 1881915585 - ADVOCATE ILLINOIS MASONIC MEDICAL CENTER | 363196629 - (IL) ADVOCATE NORTH SIDE HEALTH NETWORK | IL | General Acute Care Hospital (282N00000X) |
United | 012 | $60517.26 | 1063713659 - RCHP-WILMINGTON, LLC, CLINTON MEMORIAL HOSPITAL | 273633811 | OH | General Acute Care Hospital (282N00000X) |
United | 012 | $60517.26 | 1063713659 - RCHP-WILMINGTON, LLC, CLINTON MEMORIAL HOSPITAL | 273633811 | OH | General Acute Care Hospital (282N00000X) |
United | 012 | $74933.56 | 1316000706 - COLUMBIA ST MARY'S HOSPITAL OZAUKEE, INC., ASCENSION COLUMBIA ST MARY'S HOSPITAL OZAUKEE | 390806315 - COLUMBIA ST MARYS HOSPITAL MILWAUKEE INC | WI | General Acute Care Hospital (282N00000X) |
United | 012 | $19759.32 | 1437253085 - CALHOUN LIBERTY HOSPITAL ASSOCIATION, INC., CALHOUN-LIBERTY HOSPITAL | 593051173 - (FL) CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC | FL | Critical Access Hospital (282NC0060X) |
United | 012 | $59768.44 | 1821720681 - PARKVIEW MEDICAL CENTER, INC., PARKVIEW PUEBLO WEST | 840935136 - (CO) PARKVIEW MEDICAL CENTER INC | CO | General Acute Care Hospital (282N00000X) |
United | 012 | $64422.82 | 1417360736 - THE PRESBYTERIAN HOSPITAL, NOVANT HEALTH PRESBYTERIAN MEDICAL CENTER | 850105601 - PRESBYTERIAN HEALTHCARE SERVICES | NC | General Acute Care Hospital (282N00000X) |
United | 012 | $29032.47 | 1063175578 - MERCY HEALTH, MERCY HEALTH - ST. ANNE HOSPITAL | 344428250 - MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC | OH | General Acute Care Hospital (282N00000X) |
United | 012 | $81606.17 | 1437622933 - MEDICAL UNIVERSITY HOSPITAL AUTHORITY, MUSC HEALTH CHESTER MEDICAL CENTER | 571098556 - (SC) MEDICAL UNIVERSITY HOSPITAL AUTHORITY | SC | General Acute Care Hospital (282N00000X) |
United | 012 | $88098.22 | 1881814903 - ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC, PROVIDENCE SANTA ROSA MEMORIAL HOSPITAL | 814791043 - (CA) ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 012 | $1660.00 | 1104234376 - CARTHAGE AREA HOSPITAL, INC. | 150622079 - CARTHAGE AREA HOSPITAL INC | NY | Critical Access Hospital (282NC0060X) |
United | 012 | $61526.76 | 1538133814 - LAFAYETTE GENERAL MEDICAL CENTER INC., LAFAYETTE GENERAL SOUTHWEST | 720535375 - (LA) LAFAYETTE GENERAL MEDICAL CENTER INC | LA | Rehabilitation Hospital Unit (273Y00000X) |
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 012 vs. Other Pre-MDC Codes
The MS-DRG 012 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 012 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 |
|---|---|---|
| 011-APR-DRG | High | Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies |
| 011-MS-DRG | High | Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC |
| 012-MS-DRG | High | Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC |
| 013-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 012. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 012 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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