MS-DRG 038 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 | • Diseases & Disorders of the Nervous System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 038 by major payers:
$19,724.64
$21,060.84
$26,748.88
$27,053.77
| 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 038 | ||||||
United | 038 | $2800.00 | 1659392595 - SURGERY CENTER AT EDGEWOOD PLACE, LLC, EDGEWOOD SURGICAL HOSPITAL | 481256749 - SURGERY CENTER AT EDGEWOOD PLACE, LLC DBA EDGEWOOD SURGICAL HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 038 | $24892.97 | 1619331022 - PROSPECT CCMC, LLC | 811507712 | PA | General Acute Care Hospital (282N00000X) |
United | 038 | $17280.68 | 1285719385 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 038 | $16531.76 | 1225417421 - UPMC GREENE, WASHINGTON HEALTH SYSTEM GREENE | 473884840 - (PA) TGCH INC | PA | General Acute Care Hospital (282N00000X) |
United | 038 | $42728.44 | 1629122171 - BANNER | 270036499 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 038 | $15961.54 | 1205940236 - DARDANELLE REGIONAL, LLC, DARDANELLE REGIONAL MEDICAL CENTER | 834538290 - (AR) DARDANELLE REGIONAL LLC | AR | Psychiatric Hospital Unit (273R00000X) |
United | 038 | $5157.43 | 1275520017 - TRANSYLVANIA COMMUNITY HOSPITAL, INC, TRANSYLVANIA REGIONAL HOSPITAL | 832048854 | NC | Critical Access Hospital (282NC0060X) |
United | 038 | $14930.30 | 1295764330 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS, MEMORIAL HERMANN BAPTIST ORANGE HOSPITAL | 741303720 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 038 | $37003.50 | 1548291883 - TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN | 752890358 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN | TX | General Acute Care Hospital (282N00000X) |
United | 038 | $51964.42 | 1548291883 - TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN | 752890358 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN | TX | General Acute Care Hospital (282N00000X) |
United | 038 | $11494.00 | 1447597240 - BAYLOR UNIVERSITY MEDICAL CENTER | 751837454 - (TX) BAYLOR UNIVERSITY MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 038 | $23497.59 | 1376540138 - SENTARA HOSPITALS, SENTARA OBICI HOSPITAL | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 038 | $21111.25 | 1902125529 - VHS WEST SUBURBAN MEDICAL CENTER INC | 611899386 | IL | General Acute Care Hospital (282N00000X) |
United | 038 | $32202.78 | 1184731507 - RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA, UVA HEALTH SCIENCES CENTER | 546001796 - RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA | VA | Psychiatric Hospital Unit (273R00000X) |
United | 038 | $25735.99 | 1215913470 - PRESBYTERIAN HEALTHCARE SERVICES, PRESBYTERIAN HOSPITAL | 850105601 - PRESBYTERIAN HEALTHCARE SERVICES | NM | 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 038 vs. Other Diseases & Disorders of the Nervous System Codes
The MS-DRG 038 code is part of the Diseases & Disorders of the Nervous System 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 038 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 |
|---|---|---|
| 037-MS-DRG | High | Extracranial Procedures with MCC |
| 038-MS-DRG | High | Extracranial Procedures with CC |
| 039-MS-DRG | High | Extracranial Procedures without CC/MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 038. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 038 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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