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See a sample rate comparisonMS-DRG 264 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.
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES
| 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
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MS-DRG 264
5 of 25 sample ratesHigher to lower in this preview
The New York And Presbyterian Hospital, New York-Presbyterian Hospital
The New York And Presbyterian Hospital
$120,661.34Published rateTenet Hospitals Limited, The Hospitals Of Providence Memorial Campus
$87,816.21Published rateCarondelet Health Network, St. Mary'S Hospital
$56,192.08Published rateJohnson Memorial Hospital, Johnson Memorial Hospital
Johnson Memorial Hospital
$27,568.16Published rateWellmont Health System, Lonesome Pine Swing Bed
Wellmont Health System
$2,626.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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