MS-DRG 258 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 258 by major payers:
$33,206.85
$35,348.52
$40,739.47
$44,356.75
| 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 258 | ||||||
United | 258 | $47990.87 | 1922139807 - INOVA HEALTH CARE SERVICES, INOVA FAIR OAKS HOSPITAL | 540620889 - INOVA HEALTH CARE SERVICES | VA | Psychiatric Hospital Unit (273R00000X) |
United | 258 | $51811.96 | 1922053107 - AURORA HEALTH CARE CENTRAL, INC., AURORA MEDICAL CENTER SHEBOYGAN COUNTY | 390930748 - AURORA HEALTH CARE CENTRAL INC | WI | General Acute Care Hospital (282N00000X) |
United | 258 | $29369.34 | 1861444333 - UNITY HEALTHCARE, TRINITY MUSCATINE | 420680337 - UNITY HEALTHCARE | IA | General Acute Care Hospital (282N00000X) |
United | 258 | $30142.28 | 1841257631 - TERREBONNE PARISH HOSPITAL SERVICE DISTRICT #1, TERREBONE GENERAL REHABILITATION UNIT | 720880258 - (LA) TERREBONNE HOSPITAL SERVICE DISTRICT NO 1 | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 258 | $82481.70 | 1104845015 - TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD | 751438726 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD | TX | General Acute Care Hospital (282N00000X) |
United | 258 | $50190.39 | 1962748913 - JEFFERSON REGIONAL MEDICAL CENTER | 251260215 - (PA) HIGHMARK HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 258 | $52189.30 | 1063447167 - FORT HAMILTON HOSPITAL, THE FORT HAMILTON HOSPITAL | 310536662 - (OH) FORT HAMILTON HOSPITAL | OH | Psychiatric Hospital Unit (273R00000X) |
United | 258 | $75077.99 | 1447227491 - HEALTHALLIANCE MARYS AVENUE CAMPUS, BENEDICTINE HOSPITAL | 141338470 - (NY) HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 258 | $17175.23 | 1639936396 - PROGRESSIVE HEALTH OF HOUSTON, LLC, PROGRESSIVE HEALTH GROUP OF HOUSTON | 990736165 - (MS) PROGRESSIVE HEALTH OF HOUSTON LLC | MS | Rural Acute Care Hospital (282NR1301X) |
United | 258 | $62559.83 | 1801457510 - ADVENTHEALTH POLK NORTH INC, ADVENTHEALTH HEART OF FLORIDA | 841793121 | FL | General Acute Care Hospital (282N00000X) |
United | 258 | $36677.80 | 1639422504 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL SCHERTZ | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 258 | $18984.24 | 1689727208 - GREAT PLAINS OF OTTAWA CO INC, OTTAWA COUNTY HEALTH CENTER | 481226856 - (KS) GREAT PLAINS OF OTTAWA CO INC | KS | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 258 | $30810.00 | 1154965630 - UOFL HEALTH-LOUISVILLE INC | 843178470 - UOFL HEALTH-LOUISVILLE INC | KY | Rehabilitation Hospital (283X00000X) |
United | 258 | $41823.83 | 1922428796 - ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL INC, ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL SOMERSET | 221487243 - (NJ) ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 258 | $46447.85 | 1669509394 - APPALACHIAN REGIONAL HEALTHCARE, MIDDLESBORO ARH BC REFERENCE LAB | 520795508 - APPALACHIAN REGIONAL HEALTHCARE INC | KY | 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 |
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MS-DRG 258 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 258 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 258 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 |
|---|---|---|
| 257-MS-DRG | High | Upper Limb and Toe Amputation for Circulatory System Disorders without CC/MCC |
| 258-MS-DRG | High | Cardiac Pacer Device Replacement with MCC |
| 259-MS-DRG | High | Cardiac Pacer Device Replacement without 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 258. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 258 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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