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See a sample rate comparisonMS-DRG 421 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.
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
| 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 421 by major payers:
$22,524.81
$22,369.98
$25,911.42
$26,752.71
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MS-DRG 421
5 of 25 sample ratesHigher to lower in this preview
Desert Regional Medical Center, Inc., Desert Regional Medical Center
$49,113.26Published rateBbh Pbmc, LLC, Princeton Baptist Medical Center
$28,366.50Published ratePublic Health Trust Of Miami Dade County Florida, Jackson North Medical Center Rehab
Public Health Trust Of Miami-Dade County Florida
$25,133.88Published rateSummit Surgical LLC
$13,433.23Published rateMadison County Hospital Health Systems, Inc., Madison County Memorial Hospital
Madison County Hospital Health Systems Inc
$9,555.40Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 421 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 421 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 421 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 |
|---|---|---|
| 420-APR-DRG | High | DIABETES |
| 420-MS-DRG | High | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC |
| 421-MS-DRG | High | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC |
| 422-APR-DRG | High | HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 421. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 421 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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