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See a sample rate comparisonMS-DRG 219 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.
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC
| Key Fact | Detail |
|---|---|
| Service Type | Diseases & Disorders of the Circulatory System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 219 by major payers:
$91,093.08
$92,606.04
$113,507.01
$119,684.71
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MS-DRG 219
5 of 25 sample ratesHigher to lower in this preview
John Muir Health, John Muir Walnut Creek I/P Rehab Unit
John Muir Health
$289,815.81Published rateAhs Pryor Hospital, LLC, Hillcrest Hospital Pryor
$119,691.39Published rateOur Lady Of The Angels Hospital, Inc., Our Lady Of The Angels Hopsital - Psych
Our Lady Of The Angels Hospital Inc
$69,637.50Published rateMcallen Hospitals L P, South Texas Health System
$60,066.16Published rateMountain States Health Alliance, James H. & Cecile C. Quillen Rehabilitation Hospital
Mountain States Health Alliance
$3,891.00Published rate
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See a sample payer proposalMS-DRG 219 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 219 code is part of the Diseases & Disorders of the Circulatory 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 219 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 |
|---|---|---|
| 218-MS-DRG | High | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC |
| 219-MS-DRG | High | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC |
| 220-APR-DRG | High | MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES |
| 220-MS-DRG | High | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 219. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 219 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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