MS-DRG 018 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 018 by major payers:
$295,317.31
$384,370.33
$591,204.85
$619,619.03
| 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 018 | ||||||
United | 018 | $657409.50 | 1215135785 - NASSAU HEALTH CARE CORPORATION, NASSAU UNIVERSITTY MEDICAL CENTER - | 113465690 | NY | Substance Use Disorder Rehabilitation Hospital Unit (276400000X) |
United | 018 | $657409.50 | 1215135785 - NASSAU HEALTH CARE CORPORATION, NASSAU UNIVERSITTY MEDICAL CENTER - | 113465690 | NY | Substance Use Disorder Rehabilitation Hospital Unit (276400000X) |
United | 018 | $602424.25 | 1518346469 - SAINT THOMAS RIVER PARK HOSPITAL, LLC, ASCENSION SAINT THOMAS RIVER PARK | 474063149 | TN | General Acute Care Hospital (282N00000X) |
United | 018 | $429699.62 | 1104469873 - UOFL HEALTH-LOUISVILLE INC | 843178470 - UOFL HEALTH-LOUISVILLE INC | KY | Rehabilitation Hospital Unit (273Y00000X) |
United | 018 | $657937.50 | 1518634864 - VHS SAN ANTONIO PARTNERS, LLC, MISSION TRAIL BAPTIST HOSPITAL | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 018 | $616340.31 | 1205382413 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL ZARZAMORA | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 018 | $51697.64 | 1265512917 - HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT, HARRISON COUNTY COMMUNITY HOSPITAL | 431530883 | MO | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 018 | $882232.06 | 1356901235 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 018 | $697422.81 | 1851929954 - MERCY HOSPITAL OF BUFFALO | 160756336 - (NY) MERCY HOSPITAL OF BUFFALO | NY | General Acute Care Hospital (282N00000X) |
United | 018 | $518890.40 | 1902868391 - BAPTIST HEALTH, BAPTIST HEALTH MEDICAL CENTER- HOT SPRING COUNTY | 710236856 - (AR) BAPTIST HEALTH | AR | General Acute Care Hospital (282N00000X) |
United | 018 | $2500.00 | 1639618853 - CLHG-AVOYELLES LLC | 813465468 | LA | General Acute Care Hospital (282N00000X) |
United | 018 | $2500.00 | 1639618853 - CLHG-AVOYELLES LLC | 813465468 | LA | General Acute Care Hospital (282N00000X) |
United | 018 | $950060.87 | 1699884858 - BANNER GATEWAY MEDICAL CENTER | 900220728 | AZ | General Acute Care Hospital (282N00000X) |
United | 018 | $51697.64 | 1265512917 - HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT, HARRISON COUNTY COMMUNITY HOSPITAL | 431530883 | MO | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 018 | $903593.87 | 1346314192 - SENTARA HOSPITALS, SENTARA NORFOLK GENERAL REHABILITATION UNIT | 541547408 - SENTARA HOSPITALS | VA | 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 018 vs. Other Pre-MDC Codes
The MS-DRG 018 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 018 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 |
|---|---|---|
| 017-APR-DRG | Moderate | Liver Transplant And/Or Intestinal Transplant |
| 017-MS-DRG | High | Autologous Bone Marrow Transplant without CC/MCC |
| 018-MS-DRG | High | Chimeric Antigen Receptor (CAR) T-Cell and Other Immunotherapies |
| 019-MS-DRG | High | Simultaneous Pancreas and Kidney Transplant with Hemodialysis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 018. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 018 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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