MS-DRG 268 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 268 by major payers:
$75,650.06
$80,579.80
$98,264.30
$104,175.75
| 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 268 | ||||||
United | 268 | $80094.42 | 1518945799 - FORT SANDERS REGIONAL MEDICAL CENTER, PATRICIA NEAL REHABILITATION CENTER | 620528340 - (TN) FORT SANDERS REGIONAL MEDICAL CENTER | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 268 | $101674.22 | 1629015573 - LSUMC UNIVERSITY MEDICAL CENTER | 462605366 - (LA) UNIVERSITY HOSPITAL & CLINICS INC | LA | General Acute Care Hospital (282N00000X) |
United | 268 | $15193.25 | 1801831102 - MURPHY MEDICAL CENTER INC, ERLANGER MURPHY MEDICAL CENTER | 561844262 - (NC) MURPHY MEDICAL CENTER INC | NC | Critical Access Hospital (282NC0060X) |
United | 268 | $149914.31 | 1467537506 - CARONDELET HEALTH NETWORK, ST. MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 268 | $115234.35 | 1578506762 - CITRUS HMA LLC, BRAVERA HEALTH SEVEN RIVERS | 200195256 | FL | General Acute Care Hospital (282N00000X) |
United | 268 | $252982.92 | 1972778447 - WESTCHESTER COUNTY HEALTH CARE CORPORATION, WESTCHESTER MEDICAL CENTER | 133964321 - (NY) PEO MID-HUDSON VALLEY STAFFCO | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 268 | $168922.89 | 1902466840 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 268 | $118048.09 | 1285663856 - ROCKDALE MEDICAL CENTER INC., ROCKDALE HOSPITAL | 300999841 - (GA) PIEDMONT ROCKDALE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | 268 | $136985.84 | 1538572748 - THE PRESBYTERIAN HOSPITAL, NOVANT HEALTH HUNTERSVILLE MEDICAL CENTER | 560554230 - PRESBYTERIAN HOSPITAL | NC | General Acute Care Hospital (282N00000X) |
United | 268 | $82698.24 | 1598842643 - BOONEVILLE COMMUNITY HOSPITAL, INC | 463851119 - MERCY HOSPITAL BOONEVILLE | AR | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 268 | $98013.71 | 1134172000 - CONWAY HOSPITAL, INC., CONWAY MEDICAL CENTER | 570314381 - (SC) CONWAY HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 268 | $19203.00 | 1356828172 - HMH HOSPITALS CORPORATION, RARITAN BAY MEDICAL CENTER-OLD BRIDGE | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 268 | $63708.92 | 1982093837 - RIVERSIDE MEDICAL CENTER | 362414944 - (IL) RIVERSIDE MEDICAL CENTER | IL | Psychiatric Hospital Unit (273R00000X) |
United | 268 | $73296.92 | 1265818488 - SMSJ TUCSON HOLDINGS LLC, ST. MARYS HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 268 | $44985.19 | 1447364385 - WAYNE MEMORIAL HOSPITAL | 240798839 - (PA) WAYNE MEMORIAL HOSPITAL | PA | Rehabilitation Hospital Unit (273Y00000X) |
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 268 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 268 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 268 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 |
|---|---|---|
| 267-APR-DRG | Moderate | Other Nervous System And Related Procedures |
| 267-MS-DRG | High | Endovascular Cardiac Valve Replacement and Supplement Procedures without MCC |
| 268-MS-DRG | High | Aortic and Heart Assist Procedures except Pulsation Balloon with MCC |
| 269-APR-DRG | Moderate | 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 268. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 268 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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