MS-DRG 242 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 Circulatory System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 242 by major payers:
$43,522.54
$43,735.25
$51,166.53
$53,735.67
| 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 242 | ||||||
United | 242 | $28708.00 | 1073510277 - PEACEHEALTH, ST. JOHN MEDICAL CENTER | 910564987 | WA | General Acute Care Hospital (282N00000X) |
United | 242 | $74822.00 | 1194991232 - PARKRIDGE MEDICAL CENTER, INC., PARKRIDGE EAST HOSPITAL | 620840204 | TN | Psychiatric Hospital Unit (273R00000X) |
United | 242 | $40541.17 | 1699810523 - ST. JOSEPH HEALTH SERVICES OF RI, VASCULAR GROUP | 464661337 | RI | General Acute Care Hospital (282N00000X) |
United | 242 | $82653.00 | 1942446711 - UCSF MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 242 | $47708.00 | 1295706422 - TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA | 231352685 - TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 242 | $3083.00 | 1013143320 - HOUSTON COUNTY HEALTHCARE AUTHORITY, SOUTHEAST ALABAMA MEDICAL CENTER | 636004476 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 242 | $22580.00 | 1750749313 - PSG MID-CITIES MEDICAL CENTER, LLC, SAINT CAMILLUS MEDICAL CENTER | 810758399 - (TX) PSG MIDCITIES MEDICAL CENTER LLC | TX | General Acute Care Hospital (282N00000X) |
United | 242 | $57664.00 | 1548698723 - ES REHABILITATION LLC, EMORY REHABILITATION HOSPITAL | 463808276 | GA | Rehabilitation Hospital (283X00000X) |
United | 242 | $49116.00 | 1184722779 - REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCSD MEDICAL CENTER | 330599494 | CA | General Acute Care Hospital (282N00000X) |
United | 242 | $13902.00 | 1225133473 - MONMOUTH MEDICAL CENTER INC, MONMOUTH MEDICAL CENTER SOUTHERN CAMPUS | 223452412 | NJ | General Acute Care Hospital (282N00000X) |
United | 242 | $61133.00 | 1972527331 - SUMMA AKRON CITY AND ST. THOMAS HOSPITALS | 340714755 - SUMMA HEALTH SYSTEM | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 242 | $57664.00 | 1548698723 - ES REHABILITATION LLC, EMORY REHABILITATION HOSPITAL | 463808276 | GA | Rehabilitation Hospital (283X00000X) |
United | 242 | $91136.25 | 1386241834 - LEXINGTON HEALTH INC, LEXINGTON MEDICAL CENTER | 852276567 - LEXINGTON HEALTH INC | SC | General Acute Care Hospital (282N00000X) |
United | 242 | $61249.33 | 1639657414 - ADVOCATE NORTH SIDE HEALTH NETWORK, ADVOCATE ILLINOIS MASONIC MEDICAL CENTER PSYCH UNIT | 363196629 - (IL) ADVOCATE NORTH SIDE HEALTH NETWORK | IL | Psychiatric Hospital Unit (273R00000X) |
United | 242 | $27848.32 | 1144205360 - MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY | 730725208 | OK | Critical Access Hospital (282NC0060X) |
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 242 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 242 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 242 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 |
|---|---|---|
| 241-APR-DRG | High | PEPTIC ULCER & GASTRITIS |
| 241-MS-DRG | High | Amputation for Circulatory System Disorders except Upper Limb and Toe without CC/MCC |
| 242-MS-DRG | High | Permanent Cardiac Pacer Implant with MCC |
| 243-APR-DRG | High | OTHER ESOPHAGEAL DISORDERS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 242. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 242 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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