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 | $50959.50 | 1275886434 - PHOENIX CHILDREN'S HOSPITAL, INC., PHOENIX CHILDREN'S SURGERY CENTER - EAST VALLEY | 860422559 - (AZ) PHOENIX CHILDRENS HOSPITAL | AZ | Children's Hospital (282NC2000X) |
United | 013 | $37526.64 | 1629090402 - CARLE EUREKA HOSPITAL, ADVOCATE EUREKA HOSPITAL | 850688306 - (IL) CARLE EUREKA HOSPITAL | IL | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 013 | $65696.14 | 1316992134 - NAPLES HMA LLC, PHYSICIANS REGIONAL MEDICAL CENTER-PINE RIDGE | 204401957 | FL | General Acute Care Hospital (282N00000X) |
United | 013 | $40427.71 | 1548366404 - POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM, SENTARA NORTHERN VIRGINIA MEDICAL CENTER | 540853898 - (VA) POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM | VA | General Acute Care Hospital (282N00000X) |
United | 013 | $120463.70 | 1407016793 - DOCTORS MEDICAL CENTER, DOCTORS BEHAVIORAL HEALTH | 952588614 | CA | Psychiatric Hospital (283Q00000X) |
United | 013 | $31447.86 | 1972557064 - BILOXI HMA LLC, MERIT HEALTH BILOXI | 592754033 | MS | General Acute Care Hospital (282N00000X) |
United | 013 | $46809.60 | 1417032673 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
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 | $29048.52 | 1831170232 - GOTTLIEB MEMORIAL HOSPITAL | 362379649 - (IL) GOTTLIEB MEMORIAL HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 013 | $61657.55 | 1750346243 - ALLINA HEALTH SYSTEM, ABBOTT NORTHWESTERN HOSPITAL | 363261413 - ALLINA HEALTH SYSTEM | MN | Psychiatric Hospital Unit (273R00000X) |
United | 013 | $65696.14 | 1316992134 - NAPLES HMA LLC, PHYSICIANS REGIONAL MEDICAL CENTER-PINE RIDGE | 204401957 | FL | General Acute Care Hospital (282N00000X) |
United | 013 | $66646.06 | 1619938149 - SENTARA HOSPITALS, SENTARA WILLIAMSBURG REGIONAL MEDICAL CENTER | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 013 | $17373.40 | 1518411677 - CORRY MEMORIAL HOSPITAL ASSOCIATION, MULTI SPECIALTY GROUP | 250987222 - CORRY MEMORIAL HOSPITAL ASSOCIATION | PA | Critical Access Hospital (282NC0060X) |
United | 013 | $62245.23 | 1306814348 - THE PENNSYLVANIA HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYS | 311538725 - (PA) PENNSYLVANIA HOSPITAL OF THE UNIV OF PENNSYLVANIA HEALTH SYSTEM | PA | Psychiatric Hospital Unit (273R00000X) |
United | 013 | $32865.30 | 1306865357 - INTEGRIS CANADIAN VALLEY HOSPITAL, INTEGRIS CANADIAN VALLEY HOSPITAL | 731605613 | OK | 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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