MS-DRG 397 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 397 by major payers:
$25,834.25
$36,693.67
$38,939.40
$40,208.63
| 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 397 | ||||||
United | 397 | $72847.32 | 1770788168 - TEXAS INSTITUTE FOR SURGERY, LLP, TEXAS INSTITUTE FOR SURGERY AT TEXAS HEALTH PRESBYTERIAN DALLAS | 770628004 - (TX) TEXAS INSTITUTE FOR SURGERY, LLP | TX | General Acute Care Hospital (282N00000X) |
United | 397 | $83992.46 | 1548374549 - NEW YORK AND PRESBYTERIAN HOSPITAL, NEWYORK PRESBYTERIAN BROOKLYN METHODIST HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 397 | $43720.78 | 1730123175 - ST FRANCIS HOSPITAL INC, ST. FRANCIS-DOWNTOWN | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 397 | $30729.67 | 1932427283 - INTEGRIS BASS BAPTIST HEALTH CENTER, INTEGRIS BASS BEHAVIORAL HEALTH CENTER | 730612674 | OK | Psychiatric Hospital Unit (273R00000X) |
United | 397 | $27060.30 | 1528052578 - LECONTE MEDICAL CENTER | 621114867 - (TN) LECONTE MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 397 | $8106.00 | 1073627584 - FREEMAN-OAK HILL HEALTH SYSTEM, FREEMAN HEALTH SYSTEM | 431704371 - FREEMAN HEALTH SYSTEM | MO | Psychiatric Hospital Unit (273R00000X) |
United | 397 | $43339.19 | 1851764328 - BANNER UNIVERSITY MEDICAL CENTER-TUCSON | 901074557 | AZ | General Acute Care Hospital (282N00000X) |
United | 397 | $30199.42 | 1134826894 - PROCTOR COMMUNITY HOSPITAL | 370681540 - PROCTOR COMMUNITY HOSPITAL | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 397 | $78699.88 | 1972709970 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE EAST CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 397 | $45021.62 | 1952333205 - ST. MARY'S MEDICAL CENTER, INC, ST. MARY'S MEDICAL CENTER | 752932830 | FL | General Acute Care Hospital (282N00000X) |
United | 397 | $49865.53 | 1114079142 - TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | 751047527 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | TX | Psychiatric Hospital Unit (273R00000X) |
United | 397 | $9793.00 | 1396138970 - SCOTT & WHITE HOSPITAL, BAYLOR SCOTT & WHITE MEDICAL CENTER - MARBLE FALLS | 464007700 - (TX) SCOTT & WHITE HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 397 | $38443.07 | 1811992480 - PASCACK VALLEY HOSPITAL | 264051248 | NJ | General Acute Care Hospital (282N00000X) |
United | 397 | $23364.64 | 1639459282 - CUYUNA REGIONAL MEDICAL CENTER | 411724637 - (MN) CUYUNA REGIONAL MEDICAL CENTER | MN | Critical Access Hospital Clinic/Center (261QC0050X) |
United | 397 | $54835.01 | 1437718491 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | 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 397 vs. Other Diseases & Disorders of the Digestive System Codes
The MS-DRG 397 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 397 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 |
|---|---|---|
| 395-MS-DRG | High | Other Digestive System Diagnoses without CC/MCC |
| 397-MS-DRG | High | Appendix Procedures with MCC |
| 398-MS-DRG | High | Appendix Procedures with CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 397. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 397 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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