MS-DRG 013 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 013 by major payers:
$32,708.59
$35,549.84
$41,502.50
$42,947.96
| 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 013 | ||||||
United | 013 | $43873.39 | 1356367270 - APPALACHIAN REGIONAL HEALTHCARE, INC., MORGAN COUNTY ARH HOSPITAL | 520795508 - APPALACHIAN REGIONAL HEALTHCARE INC | KY | Critical Access Hospital (282NC0060X) |
United | 013 | $96244.21 | 1699705426 - TENET HOSPITALS LIMITED, DOCTORS HOSPITAL AT WHITE ROCK LAKE | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 013 | $29048.52 | 1831170232 - GOTTLIEB MEMORIAL HOSPITAL | 362379649 - (IL) GOTTLIEB MEMORIAL HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 013 | $96244.21 | 1699705426 - TENET HOSPITALS LIMITED, DOCTORS HOSPITAL AT WHITE ROCK LAKE | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 013 | $28732.69 | 1720419583 - STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER, UMMC GRENADA EKG/EEG SERVICES | 646008520 | MS | General Acute Care Hospital (282N00000X) |
United | 013 | $120463.70 | 1407016793 - DOCTORS MEDICAL CENTER, DOCTORS BEHAVIORAL HEALTH | 952588614 | CA | Psychiatric Hospital (283Q00000X) |
United | 013 | $120463.70 | 1407016793 - DOCTORS MEDICAL CENTER, DOCTORS BEHAVIORAL HEALTH | 952588614 | CA | Psychiatric Hospital (283Q00000X) |
United | 013 | $70050.10 | 1457526154 - SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC, BAPTIST MEDICAL CENTER | 590747311 - SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC | FL | Psychiatric Hospital (283Q00000X) |
United | 013 | $64458.60 | 1861630287 - UNIVERSITY COMMUNITY HOSPITAL, INC, ADVENTHEALTH TAMPA | 591113901 - (FL) UNIVERSITY COMMUNITY HOSPITAL INC | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 013 | $20741.39 | 1417465824 - ATHENS HOSPITAL, LLC | 823934511 | TX | General Acute Care Hospital (282N00000X) |
United | 013 | $20741.39 | 1417465824 - ATHENS HOSPITAL, LLC | 823934511 | TX | General Acute Care Hospital (282N00000X) |
United | 013 | $69379.68 | 1033475959 - ORLANDO HEALTH CENTRAL, INC., HEALTH CENTRAL | 800764192 - (FL) ORLANDO HEALTH CENTRAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 013 | $55469.80 | 1710333893 - THEDACARE MEDICAL CENTER, RIVERSIDE MEDICAL CENTER, INC. | 350983617 - COMMUNITY HEALTH NETWORK INC | WI | Critical Access Hospital (282NC0060X) |
United | 013 | $28732.69 | 1720419583 - STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER, UMMC GRENADA EKG/EEG SERVICES | 646008520 | MS | General Acute Care Hospital (282N00000X) |
United | 013 | $27885.61 | 1316902414 - MERCY HOSPITAL ROGERS, MERCY HOSPITAL NORTHWEST ARKANSAS | 710294390 - MERCY HOSPITAL ROGERS | AR | 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 013 vs. Other Pre-MDC Codes
The MS-DRG 013 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 013 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 |
|---|---|---|
| 012-APR-DRG | Moderate | Liver Transplant And/Or Intestinal Transplant |
| 012-MS-DRG | High | Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC |
| 013-MS-DRG | High | Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC |
| 014-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 013. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 013 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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