APR-DRG 222 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 |
|---|---|
| Common Place of Service | 21 - Inpatient Hospital None |
| Common Modifiers | None |
| Complexity Level | High |
National average reimbursement for APR-DRG 222 by major payers:
$44,420.61
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| 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 APR-DRG 222 | ||||||
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APR-DRG 222 vs. Other Codes
The APR-DRG 222 code is part of the null 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 APR-DRG 222 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 |
|---|---|---|
| 221-APR-DRG | High | Major Small & Large Bowel Procedures |
| 221-MS-DRG | High | Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization without CC/MCC |
| 222-APR-DRG | High | OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES |
| 223-APR-DRG | High | OTHER SMALL & LARGE BOWEL PROCEDURES |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including APR-DRG 222. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 222 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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