MS-DRG 425 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 425 by major payers:
$20,361.74
$20,194.85
$24,415.81
$25,196.78
| 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 425 | ||||||
United | 425 | $19506.23 | 1063713659 - RCHP-WILMINGTON, LLC, CLINTON MEMORIAL HOSPITAL | 273633811 | OH | General Acute Care Hospital (282N00000X) |
United | 425 | $6893.02 | 1386620045 - IBERIA REHABILITATION HOSPITAL, LLC | 263981876 - (LA) TECHE SPECIALTY HOSPITAL, LLC | LA | Rehabilitation Hospital (283X00000X) |
United | 425 | $40003.87 | 1932103413 - MOUNT SINAI HOSPITAL | 131624096 - MOUNT SINAI HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 425 | $7779.04 | 1932151487 - AMBERWELL ATCHISON ASSOCIATION, AMBERWELL ATCHISON | 480561974 - AMBERWELL ATCHISON ASSOCIATION | KS | Critical Access Hospital (282NC0060X) |
United | 425 | $46193.98 | 1548291883 - TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN | 752890358 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN | TX | General Acute Care Hospital (282N00000X) |
United | 425 | $12244.28 | 1629487848 - OSF HEALTHCARE SYSTEM, OSF SAINT ANTHONY'S HEALTH CENTER | 370813229 - (IL) OSF HEALTHCARE SYSTEM | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 425 | $79992.06 | 1164458196 - COASTAL CAROLINA MEDICAL CENTER, INC., COASTAL CAROLINA HOSPITAL-SWING BED UNIT | 934580630 | SC | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 425 | $8599.33 | 1033261045 - CAMERON REGIONAL MEDICAL CENTER INC | 440668347 - (MO) CAMERON REGIONAL MEDICAL CENTER INC | MO | General Acute Care Hospital (282N00000X) |
United | 425 | $13986.98 | 1306227764 - PRIME HEALTHCARE SERVICES-PORT HURON LLC | 472361878 | MI | General Acute Care Hospital (282N00000X) |
United | 425 | $16118.05 | 1639384399 - COX REHAB, COX MONETT HOSPITAL | 431656689 - (MO) COX-MONETT HOSPITAL INC | MO | Rural Acute Care Hospital (282NR1301X) |
United | 425 | $12610.50 | 1972503910 - WACCAMAW COMMUNITY HOSPITAL, TIDELANDS WACCAMAW COMMUNITY HOSPITAL | 43633263 - WACCAMAW COMMUNITY HOSPITAL | SC | General Acute Care Hospital (282N00000X) |
United | 425 | $21460.00 | 1144894577 - HMH HOSPITALS CORPORATION | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 425 | $43492.62 | 1598703019 - NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING, HOSPITAL FOR SPECIAL SURGERY | 131624135 - NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING | NY | General Acute Care Hospital (282N00000X) |
United | 425 | $13986.98 | 1306227764 - PRIME HEALTHCARE SERVICES-PORT HURON LLC | 472361878 | MI | General Acute Care Hospital (282N00000X) |
United | 425 | $4796.00 | 1386647717 - MSH PARTNERS, LLC, BAYLOR SCOTT & WHITE MEDICAL CENTER - UPTOWN | 752829613 | TX | 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 425 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 425 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 425 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 |
|---|---|---|
| 424-APR-DRG | High | OTHER ENDOCRINE DISORDERS |
| 424-MS-DRG | High | Other Hepatobiliary OR Pancreas O.R. Procedures with CC |
| 425-MS-DRG | High | Other Hepatobiliary OR Pancreas O.R. Procedures without CC/MCC |
| 426-APR-DRG | High | NON-HYPOVOLEMIC SODIUM 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 425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 425 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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