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 | $4286.00 | 1093876187 - WEIRTON MEDICAL CENTER | 550387249 - (WV) WEIRTON MEDICAL CENTER INC | WV | 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 | $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 | $29519.99 | 1487218509 - SMSJ TUCSON HOLDINGS, LLC, CARONDELET MARANA HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 416 | $23368.51 | 1750788667 - CARONDELET HEALTH NETWORK, BRIDGES GEROPSYCHIATRIC PROGRAM AT ST. MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 416 | $7596.62 | 1801831102 - MURPHY MEDICAL CENTER INC, ERLANGER MURPHY MEDICAL CENTER | 561844262 - (NC) MURPHY MEDICAL CENTER INC | NC | Critical Access Hospital (282NC0060X) |
United | 416 | $19972.83 | 1477809978 - RIPON MEDICAL CENTER | 391101287 - RIPON MEDICAL CENTER INC | WI | General Acute Care Hospital (282N00000X) |
United | 416 | $8106.00 | 1780747097 - FREEMAN-OAK HILL HEALTH SYSTEM | 431704371 - FREEMAN HEALTH SYSTEM | MO | General Acute Care Hospital (282N00000X) |
United | 416 | $21806.19 | 1346314192 - SENTARA HOSPITALS, SENTARA NORFOLK GENERAL REHABILITATION UNIT | 541547408 - SENTARA HOSPITALS | VA | Rehabilitation Hospital Unit (273Y00000X) |
United | 416 | $19566.46 | 1124018585 - SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION, WILSON MEMORIAL BEHAVIORAL HEALTH UNIT | 344427944 - (OH) SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION INC | OH | Psychiatric Hospital Unit (273R00000X) |
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 | $16626.00 | 1912932336 - PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA, JACKSON NORTH MEDICAL CENTER REHAB | 591713947 - (FL) PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY FLORIDA | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 416 | $21887.57 | 1659752210 - SAINT THOMAS HIGHLANDS HOSPITAL, LLC, ASCENSION SAINT THOMAS HIGHLANDS | 474063406 | TN | Psychiatric Hospital Unit (273R00000X) |
United | 416 | $10031.23 | 1770543399 - RUSH MEDICAL FOUNDATION, OCHSNER RUSH MEDICAL CENTER | 640345119 - (MS) RUSH MEDICAL FOUNDATION | MS | General Acute Care Hospital (282N00000X) |
United | 416 | $23094.61 | 1639320484 - PROVIDENCE HEALTH & SERVICES, PROV SCRED HRT MED CTR & CHLDS HOS | 364640211 | WA | Psychiatric Hospital Unit (273R00000X) |
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 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.
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