MS-DRG 411 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 411 by major payers:
$38,081.27
$36,784.45
$43,623.52
$44,459.26
| 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 411 | ||||||
United | 411 | $28546.11 | 1255785382 - ST. LUKE'S COMMUNITY HEALTH SERVICES, CHI ST. LUKE'S HEALTH - BAYLOR REHABILITATION | 760536234 - (TX) ST LUKES COMMUNITY HEALTH SERVICES | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 411 | $19349.22 | 1457351389 - COMMUNITY HEALTHCARE SYSTEM, INC, COMMUNITY HOSPITAL ONAGA & ST MARYS | 481020227 - (KS) COMMUNITY HEALTHCARE SYSTEM INC | KS | Critical Access Hospital (282NC0060X) |
United | 411 | $45405.08 | 1053718361 - PRIME HEALTHCARE SERVICES NORTH VISTA LLC | 200470861 | NV | General Acute Care Hospital (282N00000X) |
United | 411 | $28419.11 | 1033118716 - CASTRO COUNTY HOSPITAL DISTRICT, PLAINS MEMORIAL HOSPITAL | 756003939 | TX | Critical Access Hospital (282NC0060X) |
United | 411 | $5129.00 | 1457399198 - MANCHESTER MEMORIAL HOSPITAL | 812216981 | CT | General Acute Care Hospital (282N00000X) |
United | 411 | $35910.26 | 1568490506 - NORTH BROWARD HOSPITAL DISTRICT, BROWARD HEALTH IMPERIAL POINT - PSYCH | 596012065 - NORTH BROWARD HOSPITAL DISTRICT | FL | Psychiatric Hospital Unit (273R00000X) |
United | 411 | $5129.00 | 1457399198 - MANCHESTER MEMORIAL HOSPITAL | 812216981 | CT | General Acute Care Hospital (282N00000X) |
United | 411 | $65101.69 | 1700978558 - SOUTHWEST VOLUSIA HEALTHCARE CORPORATION, ADVENTHEALTH FISH MEMORIAL | 591113901 - (FL) UNIVERSITY COMMUNITY HOSPITAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 411 | $27410.51 | 1831151257 - SWEDISH COVENANT HEALTH, SWEDISH COVENANT HOSPITAL | 362179813 - (IL) SWEDISH COVENANT HEALTH | IL | General Acute Care Hospital (282N00000X) |
United | 411 | $70798.88 | 1467699199 - SENTARA HOSPITALS, SENTARA VIRGINIA BEACH GENERAL HOSPITAL | 541547408 - SENTARA HOSPITALS | VA | Rehabilitation Hospital Unit (273Y00000X) |
United | 411 | $10551.00 | 1730620428 - JERSEY CITY MEDICAL CENTER-RWJ BARNABAS HEALTH | 222783298 - (NJ) JERSEY CITY MEDICAL CENTER | NJ | General Acute Care Hospital (282N00000X) |
United | 411 | $28163.09 | 1538232244 - JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC | 470426530 - (NE) JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC | NE | Critical Access Hospital (282NC0060X) |
United | 411 | $34924.67 | 1598503922 - MERCY MEDICAL CENTER | 992367318 | IL | General Acute Care Hospital (282N00000X) |
United | 411 | $30379.50 | 1578529954 - AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY, A.O. FOX MEMORIAL HOSPITAL | 150539039 - (NY) AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY | NY | General Acute Care Hospital (282N00000X) |
United | 411 | $3665.00 | 1851435473 - SHRINERS HOSPITALS FOR CHILDREN | 362193608 - SHRINERS HOSPITALS FOR CHILDREN | KY | Children's Hospital (282NC2000X) |
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 411 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 411 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 411 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 |
|---|---|---|
| 410-APR-DRG | Moderate | Nervous System Malignancy |
| 410-MS-DRG | High | Biliary Tract Procedures except Only Cholecystectomy with OR Without C.D.E. without CC/MCC |
| 411-MS-DRG | High | Cholecystectomy with C.D.E. with MCC |
| 412-APR-DRG | Moderate | Nervous System Malignancy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 411. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 411 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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