MS-DRG 019 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 019 by major payers:
$75,490.88
$98,894.88
$124,974.56
$130,371.00
| 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 019 | ||||||
United | 019 | $182050.43 | 1245311695 - TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | 751047527 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 019 | $127019.13 | 1811984388 - MIDWESTERN REGIONAL MEDICAL CENTER, INC., MIDWESTERN REGIONAL MEDICAL CENTER, LLC. | 362510771 - MIDWESTERN REGIONAL MEDICAL CENTER INC | IL | General Acute Care Hospital (282N00000X) |
United | 019 | $124712.28 | 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 | 019 | $9486.00 | 1588659528 - RHODE ISLAND HOSPITAL | 50258954 - RHODE ISLAND HOSPITAL | RI | General Acute Care Hospital (282N00000X) |
United | 019 | $119408.92 | 1538147749 - AGNESIAN HEALTHCARE, INC, ST AGNES HOSPITAL PHYSICAL REHAB | 390807236 - AGNESIAN HEALTHCARE INC | WI | Rehabilitation Hospital Unit (273Y00000X) |
United | 019 | $219277.04 | 1174576896 - PHYSICIAN MANAGEMENT, LTD. | 210634484 - (NJ) INSPIRA MEDICAL CENTERS INC | NJ | General Acute Care Hospital (282N00000X) |
United | 019 | $78329.64 | 1295785285 - OAKWOOD HEALTHCARE, INC., COREWELL HEALTH WAYNE HOSPITAL | 381405141 - (MI) OAKWOOD HEALTHCARE INC | MI | General Acute Care Hospital (282N00000X) |
United | 019 | $2772.00 | 1255171096 - BRADLEY MEDICAL CENTER, LLC | 992892769 | TN | General Acute Care Hospital (282N00000X) |
United | 019 | $7243.00 | 1033187182 - SHASTA REGIONAL MEDICAL CENTER, LLC | 263487583 | CA | General Acute Care Hospital (282N00000X) |
United | 019 | $97505.78 | 1285705988 - MIDLAND MEMORIAL HOSPITAL | 751584559 - (TX) MIDLAND COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 019 | $35560.62 | 1699110155 - POST ACUTE SPECIALTY HOSPITAL OF TULSA LLC, PAM SPECIALTY HOSPITAL OF TULSA | 462632812 - (OK) POST ACUTE SPECIALTY HOSPITAL OF TULSA LLC | OK | Long Term Care Hospital (282E00000X) |
United | 019 | $138188.68 | 1891712485 - NASSAU HEALTH CARE CORPORATION, NASSAU UNIVER MED CENTER - REHAB | 113465690 | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 019 | $27572.08 | 1497752091 - PROVIDENCE HEALTH & SERVICES- WASHINGTON, PROVIDENCE ST LUKES REHABILITATION MEDICAL CENTER | 352347032 - PROVIDENCE HEALTH SERVICES WASHINGTON | WA | Rehabilitation Hospital (283X00000X) |
United | 019 | $147985.87 | 1861009672 - NORCAL HEALTHCONNECT LLC, HEALDSBURG HOSPITAL | 852390012 | CA | Critical Access Hospital (282NC0060X) |
United | 019 | $7243.00 | 1033187182 - SHASTA REGIONAL MEDICAL CENTER, LLC | 263487583 | CA | 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 019 vs. Other Pre-MDC Codes
The MS-DRG 019 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 019 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 |
|---|---|---|
| 018-APR-DRG | Moderate | Liver Transplant And/Or Intestinal Transplant |
| 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 019. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 019 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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