MS-DRG 422 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 422 by major payers:
$18,402.54
$19,721.92
$23,061.33
$23,925.42
| 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 422 | ||||||
United | 422 | $16153.11 | 1720454341 - SMSJ TUCSON HOLDINGS LLC, BRIDGES GEROPSYCHIATRIC PROGRAM AT ST. MARYS HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 422 | $41997.00 | 1053347955 - DELRAY MEDICAL CENTER, INC., DELRAY MEDICAL CENTER | 752922687 | FL | Psychiatric Hospital Unit (273R00000X) |
United | 422 | $28906.03 | 1700037801 - PROVIDENCE HEALTH & SERVICES-WA | 352346161 | WA | General Acute Care Hospital (282N00000X) |
United | 422 | $28906.03 | 1700037801 - PROVIDENCE HEALTH & SERVICES-WA | 352346161 | WA | General Acute Care Hospital (282N00000X) |
United | 422 | $37017.12 | 1588823553 - BANNER DEL E WEBB MEDICAL CENTER | 900389312 - (AZ) BANNER DEL E WEBB MEDICAL CENTER | AZ | General Acute Care Hospital (282N00000X) |
United | 422 | $25537.68 | 1902824758 - PROVIDENCE HEALTH SYSTEM, PROVIDENCE HOLY CROSS MEDICAL CENTER | 954582647 - (CA) PROVIDENCE HEALTH SYSTEM | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 422 | $23614.77 | 1811940976 - MACON NORTHSIDE HOSPITAL, LLC, PIEDMONT MACON NORTH HOSPITAL | 621736985 - (GA) MACON NORTHSIDE HOSPITAL LLC | GA | General Acute Care Hospital (282N00000X) |
United | 422 | $11575.79 | 1780359687 - PITT COUNTY MEMORIAL HOSPITAL INC, ECU HEALTH BEAUFORT HOSPITAL-A CAMPUS OF ECU HEALTH MEDICAL CENTER | 560585243 - (NC) PITT COUNTY MEMORIAL HOSPITAL INC | NC | General Acute Care Hospital (282N00000X) |
United | 422 | $2772.00 | 1255302006 - NATIONAL HEALTHCARE OF CLEVELAND NC, SKYRIDGE MEDICAL CENTER | 992892769 | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 422 | $38028.07 | 1144521949 - EMANUEL MEDICAL CENTER, INC., EMANUEL SPECIALTY CARE - CARDIOVASCULAR MEDICINE | 752918774 | CA | General Acute Care Hospital (282N00000X) |
United | 422 | $20849.32 | 1447082003 - NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING | 131624135 - NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING | NJ | General Acute Care Hospital (282N00000X) |
United | 422 | $5539.00 | 1255579389 - TEXAS REGIONAL MEDICAL CENTER, LLC, BAYLOR SCOTT & WHITE MEDICAL CENTER - SUNNYVALE | 510570864 - (TX) TEXAS REGIONAL MEDICAL CENTER, LTD | TX | General Acute Care Hospital (282N00000X) |
United | 422 | $19011.81 | 1881082691 - JOHN T MATHER MEMORIAL HOSPITAL | 111639818 - (NY) JOHN T MATHER MEMORIAL HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 422 | $10339.53 | 1285624825 - JOHNSON COUNTY HOSPITAL | 476000874 - (NE) JOHNSON COUNTY HOSPITAL | NE | Critical Access Hospital (282NC0060X) |
United | 422 | $28019.99 | 1538236385 - ST VINCENT JENNINGS HOSPITAL INC, SWING BED | 743107055 - (IN) ST VINCENT CARMEL HOSPITAL INC | IN | Critical Access Hospital (282NC0060X) |
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 422 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 422 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 422 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 |
|---|---|---|
| 421-APR-DRG | High | MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS |
| 421-MS-DRG | High | Hepatobiliary Diagnostic Procedures with CC |
| 422-MS-DRG | High | Hepatobiliary Diagnostic Procedures without CC/MCC |
| 423-APR-DRG | High | INBORN ERRORS OF METABOLISM |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 422. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 422 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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