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MS-DRG 407 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.

PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
Key FactDetail
Service Type

Diseases & Disorders of the Hepatobiliary System & Pancreas

Common Place of Service

21 - Inpatient Hospital

22 - On Campus Outpatient Hospital

Complexity LevelHigh

National average reimbursement for MS-DRG 407 by major payers:

bcbs

$26,430.49

uhc

$28,104.55

aetna

$33,903.45

cigna

$34,666.39

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MS-DRG 407
5 of 25 sample ratesHigher to lower in this preview
  1. Warren General Hospital

    PAMedicare Defined Swing Bed Hospital UnitNPI 1407199227Tax ID 25-0965598

    $117,900.59Published rate
  2. Uch-Mhs, Uchealth Emergency Room - Woodmen

    Uch-Mhs

    COGeneral Acute Care HospitalNPI 1578053567Tax ID 46-0796114

    $45,278.55Published rate
  3. Community Mercy Health Partners, Mercy Health - Springfield Regional Medical Center

    Community Mercy Health Partners

    OHRehabilitation Hospital UnitNPI 1831157205Tax ID 31-0785684

    $34,306.30Published rate
  4. Memorial Hermann Health System, Memorial Hermann Hospital System Rehabilitation Unit

    Memorial Hermann Health System

    TXRehabilitation Hospital UnitNPI 1669414884Tax ID 74-1152597

    $26,519.22Published rate
  5. Palisades Medical Center

    Hackensack Meridian Health Inc

    NJGeneral Acute Care HospitalNPI 1851639280Tax ID 22-1487576

    $4,193.00Published rate

National sample. Rates vary by location, specialty, and contract.

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MS-DRG 407 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes

The MS-DRG 407 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 407 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.

CodeComplexityDescription
406-APR-DRGModerateSpinal Disorders And Injuries
406-MS-DRGHighPANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
407-MS-DRGHighPANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
408-MS-DRGHighBILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. 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 407. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 407 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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