MS-DRG 405 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 405 by major payers:
$61,304.55
$69,722.62
$86,178.60
$87,951.37
| 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 405 | ||||||
United | 405 | $103091.00 | 1184786329 - COLUMBIA ST MARY'S HOSPITAL OZAUKEE, INC., ASCENSION COLUMBIA ST MARY'S HOSPITAL OZAUKEE | 390806315 - COLUMBIA ST MARYS HOSPITAL MILWAUKEE INC | WI | Psychiatric Hospital Unit (273R00000X) |
United | 405 | $48199.94 | 1306845557 - CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT 2, OLYMPIC MEDICAL CENTER | 916001709 - (WA) CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT 2 | WA | General Acute Care Hospital (282N00000X) |
United | 405 | $6143.00 | 1609800432 - THE BROOKLYN HOSPITAL CENTER | 111630755 - (NY) THE BROOKLYN HOSPITAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 405 | $113148.38 | 1053364703 - PORT CHARLOTTE HMA LLC, SHOREPOINT HEALTH PORT CHARLOTTE | 201852902 - (FL) PORT CHARLOTTE HMA LLC | FL | General Acute Care Hospital (282N00000X) |
United | 405 | $26491.32 | 1417991159 - GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION, PERSHING MEMORIAL HOSPITAL | 430715842 - (MO) GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION | MO | Critical Access Hospital (282NC0060X) |
United | 405 | $2536.00 | 1851798342 - PRIME HEALTHCARE SERVICES LOWER BUCKS LLC, LOWER BUCKS HOSPITAL | 460750728 - (PA) PRIME HEALTHCARE SERVICES LOWER BUCKS, LLC | PA | General Acute Care Hospital (282N00000X) |
United | 405 | $102542.71 | 1528463080 - PRIME HEALTHCARE SERVICES KANSAS CITY, LLC, ST. JOSEPH MEDICAL CENTER | 471669781 - (MO) PRIME HEALTHCARE SERVICES - KANSAS CITY LLC | MO | General Acute Care Hospital (282N00000X) |
United | 405 | $124268.36 | 1598755324 - ST. ANTHONY COMMUNITY HOSPITAL | 141340100 - (NY) BON SECOURS CHARITY HEALTH SYSTEM INC | NY | General Acute Care Hospital (282N00000X) |
United | 405 | $92848.93 | 1376544320 - STATE UNIVERSITY OF IOWA, UNIVERSITY OF IOWA HOSPITALS & CLINICS | 426004813 | IA | General Acute Care Hospital (282N00000X) |
United | 405 | $92848.93 | 1376544320 - STATE UNIVERSITY OF IOWA, UNIVERSITY OF IOWA HOSPITALS & CLINICS | 426004813 | IA | General Acute Care Hospital (282N00000X) |
United | 405 | $16259.30 | 1477759462 - HOSPITAL AUTHORITY OF WILKES COUNTY, WILLS MEMORIAL HOSPITAL | 586001920 - (GA) HOSPITAL AUTHORITY OF WILKES COUNTY D/B/A WILLS MEMORIAL & NURSING HOM | GA | Critical Access Hospital (282NC0060X) |
United | 405 | $51702.94 | 1477874337 - RCHP, NORTH ALABAMA MEDICAL CENTER | 272451336 | AL | General Acute Care Hospital (282N00000X) |
United | 405 | $64275.80 | 1841789427 - NEW MANNA CLG, LLC, LAKE HEALTH BEACHWOOD MEDICAL CENTER | 371848577 - (OH) NEW MANNA CLG LLC | OH | General Acute Care Hospital (282N00000X) |
United | 405 | $159603.78 | 1073664116 - PRESBYTERIAN HOSPITAL OF PLANO | 752770738 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO | TX | Psychiatric Hospital Unit (273R00000X) |
United | 405 | $5185.00 | 1679903967 - EBD BEMC BURLESON, LLC, BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL BURLESON | 364755936 | TX | 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 405 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 405 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 405 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-APR-DRG | Moderate | Spinal Disorders And Injuries |
| 402-MS-DRG | High | Single Level Combined Anterior and Posterior Spinal Fusion except Cervical |
| 405-MS-DRG | High | Pancreas, Liver and Shunt Procedures with MCC |
| 406-APR-DRG | Moderate | Spinal Disorders And Injuries |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 405 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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