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See a sample rate comparisonMS-DRG 375 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.
DIGESTIVE MALIGNANCY WITH CC
| 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 375 by major payers:
$15,033.48
$16,082.50
$19,470.28
$19,909.57
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MS-DRG 375
5 of 25 sample ratesHigher to lower in this preview
John Muir Health, John Muir Walnut Creek I/P Rehab Unit
John Muir Health
$59,428.53Published rateCommunity Health Network Rehabilitation Hospital South, LLC, Community Health Network Rehabilitation Hospital South
Community Health Network Rehabilitation Hospital South LLC
$22,635.10Published rateCommunity First Healthcare Of Illinois, Inc., Community First Medical Center
Community First Healthcare Of Il
$18,799.10Published rateClhg-Leesville, Byrd Regional Hospital
$15,053.88Published rateTakoma Hospital & Sanitarium Training School, Inc., Takoma Adventist Hospital
Takoma Regional Hospital Inc
$3,593.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 375 vs. Other Diseases & Disorders of the Digestive System Codes
The MS-DRG 375 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 375 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 |
|---|---|---|
| 374-MS-DRG | High | DIGESTIVE MALIGNANCY WITH MCC |
| 375-MS-DRG | High | DIGESTIVE MALIGNANCY WITH CC |
| 376-MS-DRG | High | DIGESTIVE MALIGNANCY 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 375. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 375 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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