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See a sample rate comparisonMS-DRG 038 Fee Schedule
Last Verified: October 2026
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.
EXTRACRANIAL PROCEDURES WITH CC
| 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
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MS-DRG 038
5 of 25 sample ratesHigher to lower in this preview
Texas Health Presbyterian Hospital Allen
$51,964.42Published rateRector & Visitors Of The University Of Virginia, Uva Health Sciences Center
Rector & Visitors Of The University Of Virginia
$32,202.78Published rateRchp Ottumwa LLC, Ottumwa Regional Health Center
$23,341.73Published rateBaptist Hospitals Of Southeast Texas, Memorial Hermann Baptist Orange Hospital
Baptist Hospitals Of Southeast Texas
$14,930.30Published rateBaylor County Hospital District, Seymour Hospital
$2,500.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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