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See a sample rate comparisonMS-DRG 304 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.
HYPERTENSION WITH 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 304 by major payers:
$12,917.43
$15,537.95
$18,881.87
$19,044.79
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MS-DRG 304
5 of 25 sample ratesHigher to lower in this preview
Doctors Medical Center Of Modesto, Inc., Doctors Behavioral Health Center
$53,404.05Published rateMercy Medical Center
$24,228.96Published rateThe Methodist Hospital, The Methodist Hospital
Methodist Hospitals Inc
$16,151.15Published rateTooele Hospital Corporation, Mountain West Medical Center
Tooele Hospital Corporation
$10,511.40Published rateSabine Medical Center
$1,200.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 304 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 304 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 304 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 |
|---|---|---|
| 303-APR-DRG | High | DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK |
| 303-MS-DRG | High | ATHEROSCLEROSIS WITHOUT MCC |
| 304-MS-DRG | High | HYPERTENSION WITH MCC |
| 305-APR-DRG | High | AMPUTATION OF LOWER LIMB EXCEPT TOES |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 304. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 304 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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