MS-DRG 421 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 421 by major payers:
$22,524.81
$22,369.98
$25,911.42
$26,752.71
| 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 421 | ||||||
United | 421 | $25299.27 | 1255785390 - PROSPECT CCMC, LLC | 811507712 | PA | Psychiatric Hospital Unit (273R00000X) |
United | 421 | $26642.10 | 1639458946 - HURON VALLEY SINAI HOSPITAL | 272844563 | MI | General Acute Care Hospital (282N00000X) |
United | 421 | $26574.97 | 1750484721 - LOYOLA UNIVERSITY MEDICAL CENTER, FOSTER G. MCGAW HOSPITAL | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 421 | $9989.19 | 1255369245 - SAINT CATHERINE HOSPITAL OF INDIANA, LLC, D/B/A SAINT CATHERINE REGIONAL HOSPITAL | 204134578 - (IN) SAINT CATHERINE HOSPITAL OF INDIANA, LLC | IN | General Acute Care Hospital (282N00000X) |
United | 421 | $11824.80 | 1952028904 - STATESVILLE HMA LLC | 562206788 - STATESVILLE HMA LLC | NC | Psychiatric Hospital (283Q00000X) |
United | 421 | $9555.40 | 1104821461 - MADISON COUNTY HOSPITAL HEALTH SYSTEMS, INC., MADISON COUNTY MEMORIAL HOSPITAL | 592319288 - (FL) MADISON COUNTY HOSPITAL HEALTH SYSTEMS INC | FL | Critical Access Hospital (282NC0060X) |
United | 421 | $29159.10 | 1659456994 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 421 | $18344.25 | 1386697688 - ORO VALLEY HOSPITAL LLC, ORO VALLEY HOSPITAL | 522379881 | AZ | General Acute Care Hospital (282N00000X) |
United | 421 | $49113.26 | 1104856095 - DESERT REGIONAL MEDICAL CENTER, INC., DESERT REGIONAL MEDICAL CENTER | 752694137 | CA | General Acute Care Hospital (282N00000X) |
United | 421 | $32666.84 | 1508956509 - THE UNIVERSITY OF CHICAGO MEDICAL CENTER | 363488183 - UNIVERSITY OF CHICAGO MEDICAL CENTER | IL | General Acute Care Hospital (282N00000X) |
United | 421 | $12516.17 | 1649794421 - POTTSTOWN HOSPITAL, LLC, POTTSTOWN HOSPITAL | 822132538 | PA | General Acute Care Hospital (282N00000X) |
United | 421 | $25905.88 | 1689737223 - SWAIN COUNTY HOSPITAL, INC. | 320441929 | NC | Critical Access Hospital (282NC0060X) |
United | 421 | $30773.77 | 1932584802 - HOLY CROSS HOSPITAL | 590791028 - HOLY CROSS HOSPITAL INC | FL | Rehabilitation Hospital (283X00000X) |
United | 421 | $20407.78 | 1225116486 - SINGING RIVER HEALTH SYSTEM, SINGING RIVER HOSPITAL COMPREHENSIVE REHABILITATION CENTER | 646000515 - SINGING RIVER HEALTH SYSTEM | MS | Rehabilitation Hospital Unit (273Y00000X) |
United | 421 | $13393.16 | 1710396932 - OSF HEALTHCARE SYSTEM, OSF SAINT ANTHONY'S HEALTH CENTER | 370813229 - (IL) OSF HEALTHCARE SYSTEM | IL | 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 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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