MS-DRG 261 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 261 by major payers:
$23,829.14
$25,101.95
$29,239.55
$30,832.69
| 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 261 | ||||||
United | 261 | $29572.19 | 1992860910 - SAINT THOMAS WEST HOSPITAL, SAINT THOMAS WEST HOSPITAL PSYCHIATRIC UNIT | 620347580 - (TN) SAINT THOMAS WEST HOSPITAL | TN | Psychiatric Hospital (283Q00000X) |
United | 261 | $28904.24 | 1023308608 - ADVOCATE LUTHERAN GENERAL HOSPITAL | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Children's Hospital (282NC2000X) |
United | 261 | $50588.12 | 1477807436 - UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS | 753175630 | TX | General Acute Care Hospital (282N00000X) |
United | 261 | $8928.00 | 1770520462 - THE MIRIAM HOSPITAL | 50258905 - THE MIRIAM HOSPITAL | RI | General Acute Care Hospital (282N00000X) |
United | 261 | $40336.98 | 1710052501 - CATHOLIC HEALTH INITIATIVES COLORADO, ST. THOMAS MORE HOSPITAL SWING BED UNIT | 840405257 - CATHOLIC HEALTH INITIATIVES COLORADO | CO | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 261 | $73687.60 | 1932103413 - MOUNT SINAI HOSPITAL | 131624096 - MOUNT SINAI HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 261 | $30891.02 | 1083692941 - FAIRVIEW HEALTH SERVICES, FAIRVIEW LAKES REGIONAL MEDICAL CENTER | 410991680 - FAIRVIEW HEALTH SERVICES | MN | General Acute Care Hospital (282N00000X) |
United | 261 | $44092.62 | 1376529743 - MORTON PLANT HOSPITAL ASSOCIATION INC, MORTON PLANT HOSPITAL | 590624462 - (FL) MORTON PLANT HOSPITAL ASSOCIATION INC | FL | General Acute Care Hospital (282N00000X) |
United | 261 | $27033.21 | 1689628794 - CATAWBA VALLEY MEDICAL CENTER | 560789196 | NC | Rehabilitation Hospital Unit (273Y00000X) |
United | 261 | $4958.00 | 1104812684 - JOHNSTON MEMORIAL HOSPITAL, INC | 540544705 - JOHNSTON MEMORIAL HOSPITAL INC | VA | General Acute Care Hospital (282N00000X) |
United | 261 | $41335.42 | 1902893415 - ASCENSION VIA CHRISTI HOSPITALS WICHITA INC. | 481172106 - ASCENSION VIA CHRISTI HOSPITALS WICHITA INC | KS | Psychiatric Hospital Unit (273R00000X) |
United | 261 | $47124.14 | 1952546616 - UNIVERSITY OF SOUTHERN CALIFORNIA, KECK HOSPITAL OF USC | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | General Acute Care Hospital (282N00000X) |
United | 261 | $79498.82 | 1912937624 - HILTON HEAD HEALTH SYSTEM, L.P., HILTON HEAD HOSPITAL | 752550947 - (SC) HILTON HEAD HEALTH SYSTEM LP | SC | General Acute Care Hospital (282N00000X) |
United | 261 | $21837.58 | 1992159925 - HOSPITAL SERVICE DISTRICT NO 1 OF IBERIA PARISH, IBERIA MEDICAL CENTER | 726014963 | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 261 | $48608.83 | 1457329435 - PAULDING MEDICAL CENTER, INC., WELLSTAR PAULDING HOSPITAL | 582095884 - (GA) PAULDING MEDICAL CENTER INC | GA | 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 261 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 261 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 261 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 |
|---|---|---|
| 260-APR-DRG | High | MAJOR PANCREAS, LIVER & SHUNT PROCEDURES |
| 260-MS-DRG | High | Cardiac Pacer Revision except Device Replacement with MCC |
| 261-MS-DRG | High | Cardiac Pacer Revision except Device Replacement with CC |
| 262-APR-DRG | High | Other Nervous System And Related Procedures |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 261. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 261 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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