MS-DRG 426 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 426 by major payers:
$116,611.82
$145,696.91
$143,700.64
$167,446.16
| 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 426 | ||||||
United | 426 | $95399.46 | 1407903586 - LUBBOCK HEART HOSPITAL | 510436196 - (TX) LUBBOCK HEART HOSPITAL, LP | TX | General Acute Care Hospital (282N00000X) |
United | 426 | $187750.59 | 1528442357 - UCHEALTH BROOMFIELD HOSPITAL | 473393862 - (CO) UCHEALTH BROOMFIELD HOSPITAL | CO | General Acute Care Hospital (282N00000X) |
United | 426 | $212682.04 | 1528031762 - NOVANT HEALTH ROWAN MEDICAL CENTER, LLC, REHABILITATION UNIT | 560547479 - (NC) ROWAN REGIONAL MEDICAL CENTER, INC. | NC | General Acute Care Hospital (282N00000X) |
United | 426 | $2954.00 | 1811915838 - TAKOMA HOSPITAL & SANITARIUM TRAINING SCHOOL, INC., TAKOMA ADVENTIST HOSPITAL | 510603966 - TAKOMA REGIONAL HOSPITAL INC | TN | Psychiatric Hospital Unit (273R00000X) |
United | 426 | $105068.25 | 1316413313 - RESILIENCE HEALTHCARE, LOUIS A. WEISS MEMORIAL HOSPITAL | 352637418 | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 426 | $5185.00 | 1619308319 - CR EMERGENCY ROOM, LLC, BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL MURPHY | 262978009 | TX | General Acute Care Hospital (282N00000X) |
United | 426 | $181182.51 | 1982799375 - LOVELACE HEALTH SYSTEM, LLC, LOVELACE WOMEN'S HOSPITAL | 850327237 | NM | General Acute Care Hospital (282N00000X) |
United | 426 | $181182.51 | 1982799375 - LOVELACE HEALTH SYSTEM, LLC, LOVELACE WOMEN'S HOSPITAL | 850327237 | NM | General Acute Care Hospital (282N00000X) |
United | 426 | $210922.18 | 1760764849 - BEAVERCREEK MEDICAL CENTER, SOIN MEDICAL CENTER | 270712680 - (OH) BEAVERCREEK MEDICAL CENTER | OH | General Acute Care Hospital (282N00000X) |
United | 426 | $74469.61 | 1104921428 - TITUSVILLE AREA HOSPITAL, TITUSVILLE AREA HOSPITAL SWING BED | 250965579 - TITUSVILLE AREA HOSPITAL | PA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 426 | $217762.62 | 1053972760 - ADVENTHEALTH POLK SOUTH INC, ADVENTHEALTH LAKE WALES | 834672945 | FL | General Acute Care Hospital (282N00000X) |
United | 426 | $217762.62 | 1053972760 - ADVENTHEALTH POLK SOUTH INC, ADVENTHEALTH LAKE WALES | 834672945 | FL | General Acute Care Hospital (282N00000X) |
United | 426 | $5761.00 | 1689002651 - CR EMERGENCY ROOM, LLC, BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL KELLER | 262978009 | TX | General Acute Care Hospital (282N00000X) |
United | 426 | $133404.21 | 1467442418 - NORTHWEST TEXAS HEALTHCARE SYSTEM INC, NORTHWEST TEXAS HEALTHCARE SYSTEM | 232238976 | TX | General Acute Care Hospital (282N00000X) |
United | 426 | $5185.00 | 1689002651 - CR EMERGENCY ROOM, LLC, BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL KELLER | 262978009 | 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 426 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 426 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 426 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 |
|---|---|---|
| 425-APR-DRG | High | OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS |
| 425-MS-DRG | High | Other Hepatobiliary OR Pancreas O.R. Procedures without CC/MCC |
| 426-MS-DRG | High | Multiple Level Combined Anterior and Posterior Spinal Fusion except Cervical with MCC or Custom-made Anatomically Designed Interbody Fusion Device |
| 427-APR-DRG | High | THYROID 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 426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 426 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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