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 | $43767.85 | 1417032541 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 397 | $41968.73 | 1699334680 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 397 | $23786.88 | 1669403846 - KITTSON MEMORIAL HOSPITAL ASSOCIATION, KITTSON MEMORIAL HOSPITAL ASSOCIATION | 410724034 - (MN) KITTSON MEMORIAL HOSPITAL ASSOCIATION | MN | Critical Access Hospital (282NC0060X) |
United | 397 | $28541.77 | 1023105566 - INGALLS MEMORIAL HOSPITAL, THE INGALLS MEMORIAL HOSPITAL | 362170866 - (IL) INGALLS MEMORIAL HOSPITAL | IL | Rehabilitation Hospital Unit (273Y00000X) |
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 | $43767.85 | 1417032541 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 397 | $25595.66 | 1295253920 - CHESTNUT HILL HOSPITAL, LLC, CHESTNUT HILL HOSPITAL | 883577015 | PA | Psychiatric Hospital Unit (273R00000X) |
United | 397 | $63037.71 | 1699176321 - LOUDOUN HOSPITAL CENTER | 540620889 - INOVA HEALTH CARE SERVICES | VA | General Acute Care Hospital (282N00000X) |
United | 397 | $43137.10 | 1114025012 - SSM HEALTH CARE OF OKLAHOMA, INC., SSM HEALTH ST. ANTHONY HOSPITAL - OKLAHOMA CITY | 730657693 - SSM HEALTH CARE OF OKLAHOMA INC | OK | Psychiatric Hospital Unit (273R00000X) |
United | 397 | $49556.00 | 1407928500 - THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA, WELLSPAN GOOD SAMARITAN HOSPITAL ACUTE CARE HOSPITAL | 230794160 - (PA) THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA | PA | General Acute Care Hospital (282N00000X) |
United | 397 | $40819.28 | 1780624049 - JAMAICA HOSPITAL, JAMAICA HOSPITAL PATHOLOGY DEPARTMENT | 111631788 - (NY) JAMAICA HOSPITAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 397 | $58597.48 | 1467764555 - VANDERBILT MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Critical Access Hospital (282NC0060X) |
United | 397 | $29789.91 | 1477537363 - VHS OF PHOENIX INC, ABRAZO CENTRAL CAMPUS | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 397 | $29789.91 | 1477537363 - VHS OF PHOENIX INC, ABRAZO CENTRAL CAMPUS | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 397 | $37907.85 | 1598829442 - METHODIST HEALTHCARE, METHODIST BEHAVIORAL HEALTH | 620479367 - METHODIST HEALTHCARE-MEMPHIS | TN | Psychiatric Hospital Unit (273R00000X) |
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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