MS-DRG 204 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 Respiratory System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 204 by major payers:
$9,427.52
$11,048.27
$12,862.14
$13,227.96
| 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 204 | ||||||
United | 204 | $10100.19 | 1942509427 - MIDTOWN | 356005697 | IN | General Acute Care Hospital (282N00000X) |
United | 204 | $27463.69 | 1548399736 - DOCTORS MEDICAL CENTER OF MODESTO, INC., DOCTORS BEHAVIORAL HEALTH CENTER | 752918774 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 204 | $14374.82 | 1811341290 - BBH BMC, LLC, BROOKWOOD MEDICAL CENTER | 474757851 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 204 | $19717.02 | 1487821237 - UNIVERSITY HOSPITAL @ SYRACUSE | 161469571 | NY | Critical Access Hospital (282NC0060X) |
United | 204 | $18600.58 | 1265698948 - UNIVERSITY OF IOWA HOSPITAL AND CLINICS | 426004813 | IA | General Acute Care Hospital (282N00000X) |
United | 204 | $12195.23 | 1720390289 - STEWARD ST. ELIZABETH'S MEDICAL CENTER OF BOSTON, INC. | 272473667 | MA | General Acute Care Hospital (282N00000X) |
United | 204 | $12216.08 | 1598841629 - RIPON MEDICAL CENTER INC | 391101287 - RIPON MEDICAL CENTER INC | WI | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 204 | $11919.24 | 1932379856 - PREFERRED HOSPITAL LEASING HEMPHILL, INC, SABINE COUNTY HOSPITAL | 261955689 | TX | Critical Access Hospital (282NC0060X) |
United | 204 | $9045.32 | 1316279003 - METROSOUTH MEDICAL CENTER, HOSPITAL | 510382045 | IL | General Acute Care Hospital (282N00000X) |
United | 204 | $3593.00 | 1265561450 - TAKOMA REGIONAL HOSPITAL, INC, GREENEVILLE COMMUNITY HOSPITAL PSYCHIATRIC | 510603966 - TAKOMA REGIONAL HOSPITAL INC | TN | Psychiatric Hospital Unit (273R00000X) |
United | 204 | $15692.04 | 1427447697 - VANDERBILT UNIVERSITY HOSPITAL | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 204 | $4158.00 | 1972606465 - MOUNTAIN STATES HEALTH ALLIANCE, JOHNSON CITY MEDICAL CENTER | 620476282 - MOUNTAIN STATES HEALTH ALLIANCE | TN | General Acute Care Hospital (282N00000X) |
United | 204 | $12415.08 | 1356328199 - EMORY UNIVERSITY, EMORY UNIVERSITY HOSPITAL | 580566256 - (GA) EMORY UNIVERSITY | GA | Rehabilitation Hospital (283X00000X) |
United | 204 | $11870.61 | 1548260839 - THEDACARE MEDICAL CENTER, SHAWANO MEDICAL CENTER, INC. | 390807068 - THEDACARE MEDICAL CENTER-SHAWANO INC | WI | Critical Access Hospital (282NC0060X) |
United | 204 | $5185.00 | 1407010622 - CR EMERGENCY ROOM LLC, BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL AUBREY | 262978009 | TX | 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 204 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 204 code is part of the Diseases & Disorders of the Respiratory 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 204 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 |
|---|---|---|
| 203-APR-DRG | High | CHEST PAIN |
| 203-MS-DRG | High | Bronchitis and Asthma without CC/MCC |
| 204-MS-DRG | High | Respiratory Signs and Symptoms |
| 205-APR-DRG | High | CARDIOMYOPATHY |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 204. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 204 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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