MS-DRG 369 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 Digestive System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 369 by major payers:
$12,549.82
$13,858.14
$16,115.60
$16,504.40
| 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 369 | ||||||
United | 369 | $14246.40 | 1164589305 - BUTLER MEMORIAL HOSPITAL, BUTLER HEALTHCARE PROVIDERS | 250965274 - (PA) BUTLER HEALTHCARE PROVIDERS | PA | General Acute Care Hospital (282N00000X) |
United | 369 | $35136.71 | 1881701217 - WASHINGTON HOSPITAL CENTER CORPORATION | 521272129 - (DC) WASHINGTON HOSPITAL CENTER CORPORATION | DC | Psychiatric Hospital (283Q00000X) |
United | 369 | $18968.59 | 1225097652 - ST. CHARLES HOSPITAL | 111871039 - (NY) ST CHARLES HOSPITAL CORP | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 369 | $11186.48 | 1285719385 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 369 | $16140.15 | 1124025176 - NORTHWESTERN LAKE FOREST HOSPITAL, NORTHWESTERN MEDICINE LAKE FOREST HOSPITAL | 362179779 - (IL) NORTHWESTERN MEMORIAL HEALTHCARE | IL | General Acute Care Hospital (282N00000X) |
United | 369 | $15897.79 | 1568562551 - MERCY HEALTH, CLERMONT HOSPITAL | 310830955 | OH | General Acute Care Hospital (282N00000X) |
United | 369 | $11186.48 | 1285719385 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 369 | $22653.81 | 1053496026 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 369 | $15897.79 | 1568562551 - MERCY HEALTH, CLERMONT HOSPITAL | 310830955 | OH | General Acute Care Hospital (282N00000X) |
United | 369 | $17761.18 | 1972535052 - OHIOHEALTH CORPORATION, DOCTORS HOSPITAL | 314394942 - OHIOHEALTH CORPORATION GRANT RIVERSIDE DOCTORS DUBLIN MET | OH | General Acute Care Hospital (282N00000X) |
United | 369 | $22672.13 | 1396882205 - VANDERBILT UNIVERSITY MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 369 | $21936.31 | 1205960903 - HARRIS METHODIST FORT WORTH | 756001743 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 369 | $9301.87 | 1295036770 - CRESCENT CITY SURGICAL CENTRE OPERATING COMPANY, L.L.C. | 270508997 - (LA) CRESCENT CITY SURGICAL CENTRE | LA | General Acute Care Hospital (282N00000X) |
United | 369 | $22653.81 | 1053496026 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 369 | $21300.40 | 1023472842 - THEDACARE REGIONAL MEDICAL CENTER, THEDA CLARK MEDICAL CENTER, INC. | 350983617 - COMMUNITY HEALTH NETWORK INC | WI | 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 369 vs. Other Diseases & Disorders of the Digestive System Codes
The MS-DRG 369 code is part of the Diseases & Disorders of the Digestive 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 369 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 |
|---|---|---|
| 368-MS-DRG | High | Major Esophageal Disorders with MCC |
| 369-MS-DRG | High | Major Esophageal Disorders with CC |
| 370-MS-DRG | High | Major Esophageal Disorders without CC/MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 369. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 369 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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