MS-DRG 243 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 243 by major payers:
$31,134.93
$31,184.41
$35,927.62
$36,809.45
| 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 243 | ||||||
United | 243 | $25261.28 | 1396835138 - CARONDELET HEALTH NETWORK, ST. MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 243 | $39121.00 | 1548426687 - REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCSD CHILDREN/ADOLESCENT PSYCHIATRY SERVICES | 330599494 | CA | Psychiatric Hospital (283Q00000X) |
United | 243 | $32890.87 | 1861465999 - DAVIESS COUNTY HOSPITAL, DAVIESS COMMUNITY HOSPITAL | 356001322 - (IN) DAVIESS COUNTY HOSPITAL | IN | General Acute Care Hospital (282N00000X) |
United | 243 | $15575.04 | 1053844761 - STEWARD TRUMBULL MEMORIAL HOSPITAL, INC. | 815457243 | OH | General Acute Care Hospital (282N00000X) |
United | 243 | $44783.41 | 1740389154 - RICHMOND MEDICAL CENTER, CASTLETON ACQUISITION CORPORATION | 743177454 - (NY) RICHMOND MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 243 | $42866.28 | 1518989946 - ALAMANCE REGIONAL MEDICAL CENTER, INC., ALAMANCE REGIONAL - BEHAVORIAL MEDICINE | 560529994 - ALAMANCE REGIONAL MEDICAL CENTER | NC | Psychiatric Hospital Unit (273R00000X) |
United | 243 | $49289.01 | 1336109107 - SENTARA HOSPITALS, SENTARA CAREPLEX HOSPITAL | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 243 | $30879.13 | 1013332014 - PROSPECT CHARTERCARE RWMC, LLC, ROGER WILLIAMS MEDICAL CENTER | 464648465 | RI | General Acute Care Hospital (282N00000X) |
United | 243 | $15575.04 | 1053844761 - STEWARD TRUMBULL MEMORIAL HOSPITAL, INC. | 815457243 | OH | General Acute Care Hospital (282N00000X) |
United | 243 | $11599.66 | 1548452261 - CHAMBERS COUNTY PUBLIC HOSPITAL DISTRICT NO 1, OMNI POINT HEALTH HOSPITAL | 760153629 | TX | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 243 | $12323.00 | 1104842475 - LOCKNEY GENERAL HOSPITAL DISTRICT, W.J. MANGOLD MEMORIAL HOSPITAL | 751424965 | TX | Critical Access Hospital (282NC0060X) |
United | 243 | $53024.80 | 1700822806 - AHS HOSPITAL CORP., MORRISTOWN MEDICAL CENTER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Rehabilitation Hospital Unit (273Y00000X) |
United | 243 | $16897.23 | 1366414534 - GUTHRIE COUNTY HOSPITAL, GUTHRIE COUNTY HOSPITAL | 426037759 | IA | Critical Access Hospital (282NC0060X) |
United | 243 | $6034.00 | 1144402819 - PRIME HEALTHCARE PARADISE VALLEY LLC, PARADISE VALLEY HOSPITAL | 205837239 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 243 | $34848.55 | 1003347279 - AHS PRYOR HOSPITAL, LLC, HILLCREST HOSPITAL PRYOR | 820651263 | OK | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
MS-DRG 243 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 243 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 243 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 |
|---|---|---|
| 242-APR-DRG | High | MAJOR ESOPHAGEAL DISORDERS |
| 242-MS-DRG | High | Permanent Cardiac Pacer Implant with MCC |
| 243-MS-DRG | High | Permanent Cardiac Pacer Implant with CC |
| 244-APR-DRG | High | DIVERTICULITIS & DIVERTICULOSIS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 243. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 243 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like MS-DRG 243) and we'll show you how you compare in 15 minutes or less.