MS-DRG 256 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 256 by major payers:
$21,000.84
$23,724.06
$26,644.15
$27,748.41
| 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 256 | ||||||
United | 256 | $51218.44 | 1568676880 - NEW YORK PRESBYTERIAN HOSPITAL, HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 256 | $26323.49 | 1205987898 - UVA PRINCE WILLIAM MEDICAL CENTER, UVA HEALTH PRINCE WILLIAM MEDICAL CENTER | 540696355 - (VA) UVA PRINCE WILLIAM MEDICAL CENTER | VA | General Acute Care Hospital (282N00000X) |
United | 256 | $17863.19 | 1962403584 - WASHINGTON COUNTY HOSPITAL | 486077010 - (KS) WASHINGTON COUNTY HOSPITAL | KS | Critical Access Hospital (282NC0060X) |
United | 256 | $27863.41 | 1548226988 - UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON, UNIVERSITY OF TEXAS MEDICAL BRANCH | 746000949 | TX | General Acute Care Hospital (282N00000X) |
United | 256 | $36627.96 | 1215755400 - ALLINA HEALTH SYSTEM | 363261413 - ALLINA HEALTH SYSTEM | MN | General Acute Care Hospital (282N00000X) |
United | 256 | $32771.39 | 1396882205 - VANDERBILT UNIVERSITY MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 256 | $12990.78 | 1972904738 - NORTHERN VIRGINIA COMMUNITY HOSPITAL LLC, STONESPRINGS HOSPITAL CENTER | 43665595 - (VA) NORTHERN VIRGINIA COMMUNITY HOSPITAL LLC | VA | General Acute Care Hospital (282N00000X) |
United | 256 | $16263.41 | 1447280284 - LORETTO HOSPITAL | 362200248 - (IL) LORETTO HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 256 | $27863.41 | 1548226988 - UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON, UNIVERSITY OF TEXAS MEDICAL BRANCH | 746000949 | TX | General Acute Care Hospital (282N00000X) |
United | 256 | $45799.33 | 1902283740 - MCLEOD HEALTH CHERAW | 473712858 - MCLEOD HEALTH CHERAW | SC | General Acute Care Hospital (282N00000X) |
United | 256 | $2723.00 | 1073598439 - VALLEY MEDICAL FACILITIES, INC., HERITAGE VALLEY KENNEDY | 251801532 - (PA) HERITAGE VALLEY HEALTH SYSTEM | PA | General Acute Care Hospital (282N00000X) |
United | 256 | $9838.20 | 1831193499 - HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA, BEAUREGARD MEMORIAL HOSPITAL | 720491106 - WEST LOUISIANA HEALTH SERVICES INC | LA | Rural Acute Care Hospital (282NR1301X) |
United | 256 | $33962.07 | 1396882205 - VANDERBILT UNIVERSITY MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 256 | $19867.09 | 1164490660 - BROOKVILLE HOSPITAL, IP PSYCHIATRIC UNIT | 250984595 - (PA) BROOKVILLE HOSPITAL | PA | Psychiatric Hospital Unit (273R00000X) |
United | 256 | $13011.01 | 1083661409 - LALLIE KEMP MEDICAL CTR, LALLIE KEMP REGIONAL MEDICAL CENTER | 726000749 | LA | 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 256 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 256 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 256 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 |
|---|---|---|
| 255-MS-DRG | High | Upper Limb and Toe Amputation for Circulatory System Disorders with MCC |
| 256-MS-DRG | High | Upper Limb and Toe Amputation for Circulatory System Disorders with CC |
| 257-MS-DRG | High | Upper Limb and Toe Amputation for Circulatory System Disorders without CC/MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 256. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 256 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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