MS-DRG 415 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 415 by major payers:
$23,956.88
$26,310.15
$31,173.89
$32,081.08
| 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 415 | ||||||
United | 415 | $17882.01 | 1235111071 - SALINE HOSPITAL LLC, SALINE MEMORIAL HOSPITAL | 812816675 | AR | General Acute Care Hospital (282N00000X) |
United | 415 | $41706.26 | 1609007525 - BELLEVUE MEDICAL CENTER LLC, BELLEVUE MEDICAL CENTER - NEBRASKA MEDICINE | 204305186 - (NE) BELLEVUE MEDICAL CENTER LLC | NE | General Acute Care Hospital (282N00000X) |
United | 415 | $29038.50 | 1437135902 - AU MEDICAL CENTER, INC | 582144788 - (GA) AU MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | 415 | $33622.00 | 1487656054 - ST. MARY'S MEDICAL CENTER | 472264005 | MO | General Acute Care Hospital (282N00000X) |
United | 415 | $30130.41 | 1548375082 - ADVOCATE HEALTH AND HOSPITALS CORPORATION, ADVOCATE CHRIST MEDICAL CENTER | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | General Acute Care Hospital (282N00000X) |
United | 415 | $66402.00 | 1225360910 - WASHINGTON HOSPITAL CENTER | 521272129 - (DC) WASHINGTON HOSPITAL CENTER CORPORATION | DC | General Acute Care Hospital (282N00000X) |
United | 415 | $30035.47 | 1619163854 - COMMUNITY HEALTH NETWORK, INC, COMMUNITY HOSPITAL NORTH | 743230935 | IN | General Acute Care Hospital (282N00000X) |
United | 415 | $26846.76 | 1700864352 - GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION | 363332852 - (IL) GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION | IL | Psychiatric Hospital Unit (273R00000X) |
United | 415 | $25484.00 | 1104909654 - DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC, MEMORIAL MEDICAL CENTER - CRICHTON REHABILITATION CENTER | 611739000 | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 415 | $32895.25 | 1619176997 - PROVIDENCE HEALTH & SERVICES WASHINGTON | 910567732 | WA | General Acute Care Hospital (282N00000X) |
United | 415 | $31194.64 | 1578124418 - AHN EMERUS WESTMORELAND LLC, AHN HARMAR NEIGHBORHOOD HOSPITAL | 823697883 - (PA) AHN EMERUS WESTMORELAND LLC | PA | General Acute Care Hospital (282N00000X) |
United | 415 | $21745.25 | 1801262423 - SMSJ TUCSON HOLDINGS LLC, ST. JOSEPHS HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 415 | $34636.00 | 1710353339 - SMSJ TUCSON HOLDINGS LLC, ST. MARYS HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 415 | $25246.49 | 1003976713 - PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK, PRESENCE ST. JOSEPH MEDICAL CENTER - PSYCHIATRIC UNIT | 364195126 - (IL) PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK | IL | Psychiatric Hospital Unit (273R00000X) |
United | 415 | $28115.63 | 1811912405 - NASSAU HEALTH CARE CORPORATION, NUMC DEPARTMENT OF NEUROLOGY, FPP | 113465690 | NY | 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 415 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 415 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 415 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 |
|---|---|---|
| 414-APR-DRG | Moderate | Nervous System Malignancy |
| 414-MS-DRG | High | Cholecystectomy except by Laparoscope without C.D.E. with MCC |
| 415-MS-DRG | High | Cholecystectomy except by Laparoscope without C.D.E. with CC |
| 416-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 415. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 415 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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