MS-DRG 424 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 424 by major payers:
$27,928.16
$30,374.94
$35,812.12
$36,907.55
| 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 424 | ||||||
United | 424 | $49627.53 | 1962766063 - MIAMI VALLEY HOSPITAL, TURNING POINT | 310537504 - (OH) MIAMI VALLEY HOSPITAL | OH | General Acute Care Hospital (282N00000X) |
United | 424 | $36094.41 | 1497119218 - THEDACARE REGIONAL MEDICAL CENTER, APPLETON MEDICAL CENTER, INC. | 350983617 - COMMUNITY HEALTH NETWORK INC | WI | General Acute Care Hospital (282N00000X) |
United | 424 | $8787.00 | 1891809679 - FREEMAN-OAK HILL HEALTH SYSTEM, FREEMAN HEALTH SYSTEM | 431704371 - FREEMAN HEALTH SYSTEM | MO | General Acute Care Hospital (282N00000X) |
United | 424 | $46308.50 | 1184638942 - UPPER VALLEY MEDICAL CENTER | 310537095 - (OH) UPPER VALLEY MEDICAL CENTER | OH | General Acute Care Hospital (282N00000X) |
United | 424 | $58046.05 | 1568435477 - THE MILTON S HERSHEY MEDICAL CENTER, PENN STATE HEALTH MILTON S HERSHEY MEDICAL CENTER | 251854772 - (PA) MILTONS S HERSHEY MEDICAL CENTER | PA | General Acute Care Hospital (282N00000X) |
United | 424 | $17232.55 | 1932160082 - MARION REGIONAL MEDICAL CENTER, INC., MARION REGIONAL MEDICAL CENTER | 640926753 - (AL) MARION REGIONAL MEDICAL CENTER INC | AL | General Acute Care Hospital (282N00000X) |
United | 424 | $34779.23 | 1073781225 - ADVOCATE HOPE CHILDREN'S HOSPITAL | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Children's Hospital (282NC2000X) |
United | 424 | $29029.56 | 1306901582 - | 420680448 - CATHOLIC HEALTH INITIATIVES-IOWA CORP | IA | Psychiatric Hospital Unit (273R00000X) |
United | 424 | $40432.00 | 1487633509 - VHS SAN ANTONIO PARTNERS LLC, BAPTIST HEALTH SYSTEM | 760714523 | TX | Psychiatric Hospital Unit (273R00000X) |
United | 424 | $46615.85 | 1700809829 - LEGACY SALMON CREEK HOSPITAL | 331065485 - LEGACY SALMON CREEK HOSPITAL | WA | General Acute Care Hospital (282N00000X) |
United | 424 | $28689.66 | 1841241841 - WESLEY HEALTH SYSTEM LLC, MERIT HEALTH WESLEY | 522050792 | MS | General Acute Care Hospital (282N00000X) |
United | 424 | $28689.66 | 1841241841 - WESLEY HEALTH SYSTEM LLC, MERIT HEALTH WESLEY | 522050792 | MS | General Acute Care Hospital (282N00000X) |
United | 424 | $42378.05 | 1598337339 - STEWARD NSMC, INC., SWING BED | 862695690 | FL | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 424 | $42378.05 | 1598337339 - STEWARD NSMC, INC., SWING BED | 862695690 | FL | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 424 | $8100.45 | 1861660920 - CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT, INC., CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL | 731506316 - (OK) CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT INC | OK | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
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 424 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 424 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 424 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 |
|---|---|---|
| 423-APR-DRG | High | INBORN ERRORS OF METABOLISM |
| 423-MS-DRG | High | Other Hepatobiliary OR Pancreas O.R. Procedures with MCC |
| 424-MS-DRG | High | Other Hepatobiliary OR Pancreas O.R. Procedures with CC |
| 425-APR-DRG | High | OTHER NON-HYPOVOLEMIC 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 424. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 424 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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