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See a sample rate comparisonMS-DRG 259 Fee Schedule
Last Verified: October 2026
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.
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC
| 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 259 by major payers:
$23,328.29
$24,450.04
$27,614.27
$28,967.33
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MS-DRG 259
5 of 25 sample ratesHigher to lower in this preview
St Mary Medical Center
$66,590.00Published rateUniversity Of Colorado Hospital Authority, Uchealth Emergency Room - Arvada
University Of Colorado Hospital Authority
$34,869.94Published rateBingham Memorial Hospital
Bmh Inc
$24,607.80Published rateVhs Acquisition Subsidiary Number 3 Inc, Louis A. Weiss Memorial Hospital
$19,418.55Published rateHouston Hospitals Inc, Perry Hospital
Houston Hospitals Inc
$3,526.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 259 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 259 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 259 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 |
|---|---|---|
| 258-MS-DRG | High | CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC |
| 259-MS-DRG | High | CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC |
| 260-APR-DRG | High | MAJOR PANCREAS, LIVER & SHUNT PROCEDURES |
| 260-MS-DRG | High | CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH 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 259. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 259 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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