MS-DRG 402 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 Hepatobiliary System & Pancreas |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 402 by major payers:
$44,390.18
$56,397.60
$61,189.36
$65,216.47
| 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 402 | ||||||
United | 402 | $57675.00 | 1053588640 - UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 402 | $89613.00 | 1659321198 - PARKRIDGE MEDICAL CENTER, INC., PARKRIDGE EAST HOSPITAL | 620840204 | TN | General Acute Care Hospital (282N00000X) |
United | 402 | $57675.00 | 1053588640 - UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 402 | $87093.39 | 1710353339 - SMSJ TUCSON HOLDINGS LLC, ST. MARYS HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 402 | $2000.00 | 1942208137 - MERIDIAN HOSPITALS CORPORATION, JERSEY SHORE UNIVERSITY MEDICAL CENTER- PSYCH CENTER | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 402 | $60013.14 | 1598971855 - OVERLAKE HOSPITAL MEDICAL CENTER LAB | 910652651 - (WA) OVERLAKE HOSPITAL MEDICAL CENTER | WA | General Acute Care Hospital (282N00000X) |
United | 402 | $111384.25 | 1295702728 - HOLMES REGIONAL MEDICAL CENTER, INC. | 590624371 - (FL) HOLMES REGIONAL MEDICAL CENTER | FL | General Acute Care Hospital (282N00000X) |
United | 402 | $125886.77 | 1417192311 - ST LUKES ROOSEVELT HOSPITAL CENTER, REHABILITATION UNIT | 132997301 - (NY) ST LUKES ROOSEVELT HOSPITAL CENTER | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 402 | $89613.00 | 1659321198 - PARKRIDGE MEDICAL CENTER, INC., PARKRIDGE EAST HOSPITAL | 620840204 | TN | General Acute Care Hospital (282N00000X) |
United | 402 | $78791.71 | 1326002049 - UNIVERSITY OF WASHINGTON, UNIVERSITY OF WASHINGTON MEDICAL CENTER | 916001537 | WA | General Acute Care Hospital (282N00000X) |
United | 402 | $67665.40 | 1649373887 - LOVELACE HEALTH SYSTEM, LLC, LOVELACE WESTSIDE HOSPITAL | 850327237 | NM | General Acute Care Hospital (282N00000X) |
United | 402 | $17641.00 | 1972517365 - COVENANT MEDICAL CENTER | 822913146 - (TX) COVENANT MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 402 | $59923.00 | 1376719419 - HCA HEALTH SERVICES OF TENNESSEE, INC., TRISTAR SOUTHERN HILLS MEDICAL CENTER | 621113737 - HCA HEALTH SERVICES OF TENNESSEE INC | TN | Psychiatric Hospital Unit (273R00000X) |
United | 402 | $75536.75 | 1982629440 - EMANATE HEALTH MEDICAL CENTER, CITRUS VALLEY MEDICAL CENTER INTER-COMMUNITY CAMPUS | 956006469 - (CA) EMANATE HEALTH MEDICAL CENTER | CA | General Acute Care Hospital (282N00000X) |
United | 402 | $166127.65 | 1649415571 - BETH ISRAEL MEDICAL CENTER, MILTON AND CARROLL PETRIE DIVISION | 135564934 - (NY) BETH ISRAEL MEDICAL CENTER | NY | Rehabilitation Hospital Unit (273Y00000X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
MS-DRG 402 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 402 code is part of the Diseases & Disorders of the Hepatobiliary System & Pancreas 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 402 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 |
|---|---|---|
| 402-MS-DRG | High | Single Level Combined Anterior and Posterior Spinal Fusion except Cervical |
| 405-APR-DRG | High | OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS |
| 405-MS-DRG | High | Pancreas, Liver and Shunt Procedures with 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 402. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 402 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like MS-DRG 402) and we'll show you how you compare in 15 minutes or less.