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 | $157945.28 | 1033186093 - MOUNT SINAI HOSPITAL | 131624096 - MOUNT SINAI HOSPITAL | NY | Psychiatric Hospital (283Q00000X) |
United | 423 | $57539.42 | 1932489713 - AHS CLAREMORE REGIONAL HOSPITAL LLC, HILLCREST HOSPITAL CLAREMORE | 452652006 | OK | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 423 | $59320.57 | 1770560294 - EMORY UNIVERSITY, EMORY UNIVERSITY HOSPITAL AT WESLEY WOODS | 580566256 - (GA) EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | 423 | $93281.75 | 1114949781 - CARLSBAD MEDICAL CENTER LLC, CARLSBAD MEDICAL CENTER - REHAB | 621762526 - (NM) CARLSBAD MEDICAL CENTER LLC | NM | Rehabilitation Hospital Unit (273Y00000X) |
United | 423 | $63634.46 | 1083644033 - CLEVELAND CLINIC WESTON HOSPITAL NONPROFIT CORPORATION, CLEVELAND CLINIC HOSPITAL | 650844880 - (FL) CLEVELAND CLINIC WESTON HOSPITAL NO NPROFIT CORPORATION | FL | 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 | $46856.44 | 1275523912 - NORTH ARKANSAS REGIONAL MEDICAL CENTER, NORTH ARKANSAS MEDICAL CENTER, BOONE COUNTY HOSPITAL | 710787860 - (AR) NORTH ARKANSAS REGIONAL MEDICAL CENTER | AR | General Acute Care Hospital (282N00000X) |
United | 423 | $71590.31 | 1992815195 - OCHSNER BAPTIST MEDICAL CENTER | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | General Acute Care Hospital (282N00000X) |
United | 423 | $50443.89 | 1588243117 - INTEGRIS HEALTH EDMOND, INC, INTEGRIS HEALTH JIM THORPE REHABILITATION HOSPITAL EDMOND | 451027361 - (OK) INTEGRIS HEALTH EDMOND INC | OK | Rehabilitation Hospital Unit (273Y00000X) |
United | 423 | $81136.50 | 1033218128 - THE UNIVERSITY OF CHICAGO MEDICAL CENTER | 363488183 - UNIVERSITY OF CHICAGO MEDICAL CENTER | IL | General Acute Care Hospital (282N00000X) |
United | 423 | $27834.61 | 1821098286 - TOURO INFIRMARY | 720423659 - (LA) TOURO INFIRMARY | LA | General Acute Care Hospital (282N00000X) |
United | 423 | $21509.94 | 1790785095 - SOUTHFIELD REHABILITATION COMPANY, SURGEONS CHOICE MEDICAL CENTER | 383162435 - (MI) SURGEONS CHOICE MEDICAL CENTER | MI | General Acute Care Hospital (282N00000X) |
United | 423 | $29343.46 | 1518911031 - GALEN OF FLORIDA, INC., HCA FLORIDA ST. PETERSBURG HOSPITAL | 591174716 - (FL) GALEN OF FLORIDA INC | FL | General Acute Care Hospital (282N00000X) |
United | 423 | $96133.00 | 1235162645 - NORCAL HEALTHCONNECT LLC, PETALUMA VALLEY HOSPITAL | 852390012 | CA | General Acute Care Hospital (282N00000X) |
United | 423 | $42511.48 | 1467521146 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH ST. JOSEPH HOSPITAL - ST. CHARLES | 431343281 - SSM HEALTH CARE ST LOUIS | MO | 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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