MS-DRG 416 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 416 by major payers:
$16,897.10
$18,581.63
$21,635.27
$22,398.07
| 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 416 | ||||||
United | 416 | $23885.33 | 1891712485 - NASSAU HEALTH CARE CORPORATION, NASSAU UNIVER MED CENTER - REHAB | 113465690 | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 416 | $23368.51 | 1750788667 - CARONDELET HEALTH NETWORK, BRIDGES GEROPSYCHIATRIC PROGRAM AT ST. MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 416 | $16169.73 | 1407076631 - ST. MARY'S HEALTH CENTER | 431343281 - SSM HEALTH CARE ST LOUIS | MO | Critical Access Hospital (282NC0060X) |
United | 416 | $21887.57 | 1659752210 - SAINT THOMAS HIGHLANDS HOSPITAL, LLC, ASCENSION SAINT THOMAS HIGHLANDS | 474063406 | TN | Psychiatric Hospital Unit (273R00000X) |
United | 416 | $23983.98 | 1992100127 - MERCY HEALTH YOUNGSTOWN LLC, MERCY HEALTH ST ELIZABETH YOUNGSTOWN HOSPITAL | 340505560 - HUMILITY OF MARY HEALTH PARTNERS | OH | Psychiatric Hospital Unit (273R00000X) |
United | 416 | $23094.61 | 1639320484 - PROVIDENCE HEALTH & SERVICES, PROV SCRED HRT MED CTR & CHLDS HOS | 364640211 | WA | Psychiatric Hospital Unit (273R00000X) |
United | 416 | $24203.21 | 1518042605 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 416 | $31837.97 | 1518604693 - BAYCARE PASCO, INC., BAYCARE HOSPITAL WESLEY CHAPEL | 832099849 - (FL) BAYCARE PASCO INC | FL | General Acute Care Hospital (282N00000X) |
United | 416 | $23885.33 | 1891712485 - NASSAU HEALTH CARE CORPORATION, NASSAU UNIVER MED CENTER - REHAB | 113465690 | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 416 | $17161.84 | 1114473329 - EMERUS BHS SA THOUSAND OAKS LLC, BAPTIST NEIGHBORHOOD HOSPITAL SHAVANO PARK | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 416 | $39605.62 | 1437575040 - WESTCHESTER COUNTY HEALTH CARE CORPORATION, MID-HUDSON VALLEY DIVISION OF WESTCHESTER MEDICAL CENTER | 133964321 - (NY) PEO MID-HUDSON VALLEY STAFFCO | NY | Psychiatric Hospital Unit (273R00000X) |
United | 416 | $29637.42 | 1447275037 - SOUTHCOAST HOSPITALS GROUP, INC, ST. LUKE'S HOSPITAL | 222592333 - SOUTHCOAST HOSPITALS GROUP INC | MA | General Acute Care Hospital (282N00000X) |
United | 416 | $22471.27 | 1033854153 - BOSTON MEDICAL CENTER CORPORATION, BMC BROCKTON BEHAVIORAL HEALTH CENTER | 43314093 - (MA) BOSTON MEDICAL CENTER CORPORATION | MA | Psychiatric Hospital Unit (273R00000X) |
United | 416 | $23094.61 | 1639320484 - PROVIDENCE HEALTH & SERVICES, PROV SCRED HRT MED CTR & CHLDS HOS | 364640211 | WA | Psychiatric Hospital Unit (273R00000X) |
United | 416 | $25764.83 | 1912334517 - FAUQUIER MEDICAL CENTER LLC, FAUQUIER HOSPITAL | 463107896 | VA | 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 |
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 416 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 416 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 416 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 |
|---|---|---|
| 415-APR-DRG | Moderate | Nervous System Malignancy |
| 415-MS-DRG | High | Cholecystectomy except by Laparoscope without C.D.E. with CC |
| 416-MS-DRG | High | Cholecystectomy except by Laparoscope without C.D.E. without CC/MCC |
| 417-MS-DRG | High | Laparoscopic Cholecystectomy 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 416. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 416 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 416) and we'll show you how you compare in 15 minutes or less.