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See a sample rate comparisonMS-DRG 425 Fee Schedule
Last Verified: October 2026
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.
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC
| 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
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MS-DRG 425
5 of 25 sample ratesHigher to lower in this preview
Coastal Carolina Medical Center, Inc., Coastal Carolina Hospital-Swing Bed Unit
$79,992.06Published rateWinter Haven Hospital Inc, Mid Florida Medical Servies
Winter Haven Hospital Inc
$31,020.78Published rateNassau Health Care Corporation, Nassau Univer Med Center - Rehab
$25,327.64Published rateNorthwest Hospital LLC, Northwest Medical Center
$16,560.16Published rateCameron Regional Medical Center Inc
$8,599.33Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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