MS-DRG 264 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 264 by major payers:
$38,622.39
$44,539.16
$54,299.97
$56,357.85
| 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 264 | ||||||
United | 264 | $64386.73 | 1790285500 - COMMUNITY HEALTH NETWORK REHABILITATION HOSPITAL SOUTH, LLC, COMMUNITY HEALTH NETWORK REHABILITATION HOSPITAL SOUTH | 821385366 - (IN) COMMUNITY HEALTH NETWORK REHABILITATION HOSPITAL SOUTH LLC | IN | Rehabilitation Hospital (283X00000X) |
United | 264 | $56192.08 | 1700961869 - CARONDELET HEALTH NETWORK, ST. MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 264 | $88048.56 | 1558521070 - BANNER BOSWELL MEDICAL CENTER | 900389314 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 264 | $63918.39 | 1184038663 - NEW YORK SOCIETY FOR THE RELIEF OF THE RUPTURED AND CRIPPLED, HOSPITAL FOR SPECIAL SURGERY | 131624135 - NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING | NJ | General Acute Care Hospital (282N00000X) |
United | 264 | $120661.34 | 1790969269 - THE NEW YORK AND PRESBYTERIAN HOSPITAL, NEW YORK-PRESBYTERIAN HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 264 | $2626.00 | 1447285432 - WELLMONT HEALTH SYSTEM, LONESOME PINE SWING BED | 621636465 - WELLMONT HEALTH SYSTEM | VA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 264 | $3083.00 | 1295161396 - MANAGED HEALTH CARE ADMINISTRATION, INC | 636004476 | AL | General Acute Care Hospital (282N00000X) |
United | 264 | $101526.88 | 1396028205 - ANMED HEALTH, ANMED PEDIATRIC HOSPITALISTS | 570359174 - ANMED HEALTH | SC | Hospitalist Physician (208M00000X) |
United | 264 | $24900.31 | 1396731105 - DOCTORS HOSPITAL OF LAREDO, DOCTORS HOSPITAL OF LAREDO | 233001904 | TX | General Acute Care Hospital (282N00000X) |
United | 264 | $87816.21 | 1700801909 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE MEMORIAL CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 264 | $94308.28 | 1912982216 - ST JOSEPH HOSPITAL OF ORANGE, PROVIDENCE ST. JOSEPH HOSPITAL | 951643359 - (CA) ST JOSEPH HOSPITAL OF ORANGE | CA | General Acute Care Hospital (282N00000X) |
United | 264 | $29603.00 | 1275573123 - CHIPPENHAM & JOHNSTON-WILLIS HOSPITALS INC, CJW MEDICAL CENTER | 541779911 | VA | Psychiatric Hospital Unit (273R00000X) |
United | 264 | $27568.16 | 1346248986 - JOHNSON MEMORIAL HOSPITAL, JOHNSON MEMORIAL HOSPITAL | 351166081 - JOHNSON MEMORIAL HOSPITAL | IN | General Acute Care Hospital (282N00000X) |
United | 264 | $32560.83 | 1659559573 - ST LUKES COMMUNITY DEVELOPMENT CORPORATION, ST LUKES SUGAR LAND HOSPITAL | 261947374 - (TX) ST LUKES COMMUNITY DEVELOPMENT CORPORATION-SUGAR LAND | TX | General Acute Care Hospital (282N00000X) |
United | 264 | $18384.06 | 1144664954 - PEACEHEALTH UNITED GENERAL MEDICAL CENTER, UNITED GENERAL MEDICAL CENTER | 371715059 | WA | 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 264 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 264 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 264 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 |
|---|---|---|
| 263-APR-DRG | High | CHOLECYSTECTOMY |
| 263-MS-DRG | High | Vein Ligation and Stripping |
| 264-MS-DRG | High | Other Circulatory System O.R. Procedures |
| 265-MS-DRG | High | AICD Lead 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 264. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 264 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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