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 | $58943.64 | 1487868097 - PRISMA HEALTH-MIDLANDS | 582296052 - (SC) PRISMA HEALTH-MIDLANDS | SC | General Acute Care Hospital (282N00000X) |
United | 424 | $14771.58 | 1992904163 - SELECT SPECIALTY HOSPITAL GAINESVILLE LLC | 61713547 - (FL) SELECT SPECIALTY HOSPITAL GAINESVILLE LLC | FL | Long Term Care Hospital (282E00000X) |
United | 424 | $30660.75 | 1053606905 - MORRISTOWN MEDICAL CENTER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 424 | $36102.19 | 1801299375 - OCHSNER MEDICAL CENTER, OCHSNER MEDICAL COMPLEX - RIVER PARISHES | 205432782 | LA | Critical Access Hospital (282NC0060X) |
United | 424 | $4958.00 | 1821477456 - JOHNSTON MEMORIAL HOSPITAL, INC, CENTER FOR SLEEP DISORDERS AT JMH | 540544705 - JOHNSTON MEMORIAL HOSPITAL INC | VA | General Acute Care Hospital (282N00000X) |
United | 424 | $10219.37 | 1023018835 - WARDS 3 4 & 10 HOSPITAL SERVICE DISTRICT PARISH OF UNION, REEVES MEMORIAL MEDICAL CENTER | 720685207 | LA | Critical Access Hospital (282NC0060X) |
United | 424 | $62649.19 | 1689978280 - COLUMBIA MHC | 852276567 - LEXINGTON HEALTH INC | SC | General Acute Care Hospital (282N00000X) |
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 | 424 | $21042.89 | 1073598439 - VALLEY MEDICAL FACILITIES, INC., HERITAGE VALLEY KENNEDY | 251801532 - (PA) HERITAGE VALLEY HEALTH SYSTEM | PA | General Acute Care Hospital (282N00000X) |
United | 424 | $38944.03 | 1154741577 - ALLINA HEALTH SYSTEM, ALLINA HEALTH FARIBAULT MEDICAL CENTER | 363261413 - ALLINA HEALTH SYSTEM | MN | General Acute Care Hospital (282N00000X) |
United | 424 | $35594.35 | 1619916806 - ST JOSEPH MEDICAL CENTER, OSF SAINT JOSEPH MEDICAL CENTER | 370662576 | IL | General Acute Care Hospital (282N00000X) |
United | 424 | $29112.08 | 1518197011 - UNITED SURGEONS, LLC, UNITY PHYSICIANS HOSPITAL | 352194353 - (IN) UNITED SURGEONS, LLC | IN | General Acute Care Hospital (282N00000X) |
United | 424 | $56376.96 | 1598742918 - OCHSNER CLINIC FOUNDATION, OSHSNER FOUNDATION HOSPITAL REHAB | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 424 | $70873.25 | 1902463243 - MCKEE MEDICAL CENTER | 840826332 - (CO) MCKEE MEDICAL CENTER | CO | Psychiatric Hospital Unit (273R00000X) |
United | 424 | $19744.65 | 1083753610 - HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF ST. MARY, BAYOU BEND HEALTH SYSTEM | 726008504 - (LA) HOSPITAL SERVICE DISTRICT NO 1 OF THE PARISH OF ST MARY | LA | 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 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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