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 | $10221.83 | 1407191984 - BSA HOSPITAL LLC | 300754305 | TX | General Acute Care Hospital (282N00000X) |
United | 204 | $13464.21 | 1477579464 - NASSAU HEALTH CARE CORPORATION, NUMC DEPARTMENT OF RADIOLOGY, FFP | 113465690 | NY | General Acute Care Hospital (282N00000X) |
United | 204 | $16633.00 | 1962504340 - TEXAS HEART HOSPITAL OF THE SOUTHWEST LLP, BAYLOR SCOTT & WHITE THE HEART HOSPITAL - PLANO | 412101361 - (TX) TEXAS HEART HOSPITAL OF THE SOUTHWEST, L.L.P | TX | 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 | $7225.99 | 1689629941 - METHODIST HOSPITALS OF DALLAS, METHODIST MANSFIELD MEDICAL CENTER | 750800661 - METHODIST HOSPITALS OF DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 204 | $8799.00 | 1801503313 - ORLANDO HEALTH, INC. | 591726273 - (FL) ORLANDO HEALTH INC | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 204 | $27463.69 | 1548399736 - DOCTORS MEDICAL CENTER OF MODESTO, INC., DOCTORS BEHAVIORAL HEALTH CENTER | 752918774 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 204 | $21806.05 | 1326086570 - | 390987025 - (WI) COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC | WI | Rehabilitation Hospital Unit (273Y00000X) |
United | 204 | $11835.04 | 1346228541 - AGNESIAN HEALTHCARE, INC, SSM HEALTH ST AGNES HOSPITAL FOND DU LAC | 390807236 - AGNESIAN HEALTHCARE INC | WI | General Acute Care Hospital (282N00000X) |
United | 204 | $17521.08 | 1053353490 - SAINT LUKES EAST HOSPITAL, SAINT LUKE'S EAST LEE'S SUMMIT HOSPITAL | 562488077 - (MO) SAINT LUKES EAST HOSPITAL | MO | General Acute Care Hospital (282N00000X) |
United | 204 | $18447.82 | 1447227491 - HEALTHALLIANCE MARYS AVENUE CAMPUS, BENEDICTINE HOSPITAL | 141338470 - (NY) HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 204 | $12560.75 | 1851386692 - PALOS COMMUNITY HOSPITAL | 362169179 - (IL) NORTHWESTERN MEMORIAL HEALTHCARE | IL | General Acute Care Hospital (282N00000X) |
United | 204 | $1518.00 | 1902901200 - MENA HOSPITAL COMMISSION, MENA REGIONAL HEALTH SYSTEM REHAB UNIT | 710708660 - (AR) MENA HOSPITAL COMMISSION | AR | Rehabilitation Hospital Unit (273Y00000X) |
United | 204 | $8134.33 | 1770568123 - VHS ACQUISITION SUBSIDIARY NUMBER 3 INC, LOUIS A. WEISS MEMORIAL HOSPITAL | 352637418 | IL | 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 | 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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