MS-DRG 423 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 423 by major payers:
$47,250.05
$52,904.45
$63,698.29
$65,429.57
| 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 423 | ||||||
United | 423 | $69594.46 | 1982150009 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH GREER MEMORIAL HOSPITAL | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 423 | $38497.23 | 1154363406 - BOTSFORD GENERAL HOSPITAL, BEAUMONT HOSPITAL-FARMINGTON HILLS | 381426919 - (MI) BOTSFORD GENERAL HOSPITAL | MI | Rehabilitation Hospital Unit (273Y00000X) |
United | 423 | $84842.56 | 1063470953 - NIOBRARA VALLEY HOSPITAL CORPORATION, NIOBRARA VALLEY HOSPITAL | 470537192 - (NE) NIOBRARA VALLEY HOSPITAL CORPORATION | NE | Critical Access Hospital (282NC0060X) |
United | 423 | $85704.18 | 1730710898 - FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC, FROEDTERT COMMUNITY HOSPITAL | 843381796 | WI | General Acute Care Hospital (282N00000X) |
United | 423 | $60390.05 | 1013985126 - JEFFERSON REGIONAL MEDICAL CENTER | 251260215 - (PA) HIGHMARK HEALTH | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 423 | $112778.61 | 1922344167 - TEXAS HEALTH ARLINGTON MEMORIAL | 750972805 - (TX) TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 423 | $78909.29 | 1366444507 - COMMUNITY MEDICAL CENTER, GEISINGER COMMUNITY MEDICAL CENTER | 240862246 - (PA) COMMUNITY MEDICAL CENTER | PA | General Acute Care Hospital (282N00000X) |
United | 423 | $73721.63 | 1962472860 - ROPER HOSPITAL, INC | 570828733 - ROPER HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 423 | $48104.07 | 1285705988 - MIDLAND MEMORIAL HOSPITAL | 751584559 - (TX) MIDLAND COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 423 | $35638.73 | 1770531600 - NORTHWEST COMMUNITY HOSPITAL | 362340313 - NORTHWEST COMMUNITY HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 423 | $37448.55 | 1376584110 - CLARKSDALE HMA LLC, NORTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER | 853959101 | MS | General Acute Care Hospital (282N00000X) |
United | 423 | $59140.62 | 1548207608 - UNIVERSITY HEALTHCARE SYSTEM, L.C., EAST JEFFERSON GENERAL HOSPITAL | 621596506 | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 423 | $37448.55 | 1376584110 - CLARKSDALE HMA LLC, NORTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER | 853959101 | MS | General Acute Care Hospital (282N00000X) |
United | 423 | $47783.82 | 1063764371 - EAST LIVERPOOL CITY HOSPITAL | 340714583 - (OH) CITY HOSPITAL ASSOCIATION | OH | General Acute Care Hospital (282N00000X) |
United | 423 | $27834.61 | 1821098286 - TOURO INFIRMARY | 720423659 - (LA) TOURO INFIRMARY | LA | 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 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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