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 | $87200.29 | 1205203775 - PLANO SURGICAL HOSPITAL | 843385649 | TX | General Acute Care Hospital (282N00000X) |
United | 019 | $148549.67 | 1255640819 - VHS OF ARROWHEAD, INC., ABRAZO ARIZONA HEART HOSPITAL | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 019 | $93090.28 | 1083013478 - NATCHEZ HOSPITAL COMPANY LLC, MERIT HEALTH NATCHEZ | 371756496 | MS | Rehabilitation Hospital Unit (273Y00000X) |
United | 019 | $55735.67 | 1659323772 - COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP, MEDICAL CITY FORT WORTH | 621682202 - (TX) COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 019 | $115366.00 | 1740920909 - THEDACARE REGIONAL MEDICAL CENTER, THEDACARE MEDICAL CENTER ORTHOPEDICS, SPINE, AND PAIN | 390824015 - (WI) THEDACARE REGIONAL MEDICAL CENTER- APPLETON INC | WI | General Acute Care Hospital (282N00000X) |
United | 019 | $61254.25 | 1013122571 - MIDWEST SURGICAL HOSPITAL, L.L.C. | 383712521 - (NE) MIDWEST SURGICAL HOSPITAL, LLC | NE | Special Hospital (284300000X) |
United | 019 | $60588.35 | 1750354965 - POTTSTOWN HOSPITAL COMPANY, LLC, POTTSTOWN MEMORIAL MEDICAL CENTER | 822132538 | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 019 | $114121.40 | 1083873111 - ABINGTON MEMORIAL HOSPITAL | 231352152 - ABINGTON MEMORIAL HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 019 | $11052.00 | 1376104125 - CHILDREN'S HOSPITAL COLORADO, CHILDREN'S COLORADO - HEALTH PAVILION | 840166760 - CHILDRENS HOSPITAL COLORADO | CO | Children's Hospital (282NC2000X) |
United | 019 | $296924.93 | 1801821376 - JOHN MUIR HEALTH, JOHN MUIR HEALTH MEDICAL CENTER, CONCORD CAMPUS | 680396600 | CA | General Acute Care Hospital (282N00000X) |
United | 019 | $195105.34 | 1366932162 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY, UCHEALTH EMERGENCY ROOM - THORNTON | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 019 | $57513.44 | 1669477089 - DALLAS COUNTY HOSPITAL | 426037739 | IA | Critical Access Hospital (282NC0060X) |
United | 019 | $6520.00 | 1215914254 - JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC. | 730606129 - JANE PHILLIPS MEMORIAL MEDICAL CENTER INC | OK | General Acute Care Hospital (282N00000X) |
United | 019 | $63680.00 | 1548364961 - HOMER MEMORIAL HOSPITAL, CLAIBORNE MEMORIAL MEDICAL CENTER | 720396868 - (LA) HOMER MEMORIAL HOSPITAL | LA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 019 | $2772.00 | 1255171096 - BRADLEY MEDICAL CENTER, LLC | 992892769 | TN | 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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