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See a sample rate comparisonMS-DRG 423 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.
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC
| 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 423 by major payers:
$47,250.05
$52,904.45
$63,698.29
$65,429.57
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MS-DRG 423
5 of 25 sample ratesHigher to lower in this preview
Mount Sinai Hospital
$157,945.28Published rateForsyth Memorial Hospital, Inc., Novant Health Forsyth Behavioral Health
Forsyth Memorial Hospital Inc
$91,439.21Published rateNassau Healthcare Corporation, Numc Department Of Pathology, Fpp
$67,526.96Published rateSsm Health Care St. Louis, Ssm Health St. Joseph Hospital - St. Charles
Ssm Health Care St Louis
$42,511.48Published rateNorth Central Surgical Center L.L.P.
North Central Surgical Center LLP
$5,185.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 423 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 423 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 423 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 |
|---|---|---|
| 422-APR-DRG | High | HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS |
| 422-MS-DRG | High | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC |
| 423-MS-DRG | High | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC |
| 424-APR-DRG | High | OTHER ENDOCRINE 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 423. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 423 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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