MS-DRG 428 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 428 by major payers:
$61,452.92
$77,523.15
$80,374.78
$89,404.20
| 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 428 | ||||||
United | 428 | $104957.67 | 1639124134 - ST. VINCENT CARMEL HOSPITAL, INC., ASCENSION ST. VINCENT CARMEL | 743107055 - (IN) ST VINCENT CARMEL HOSPITAL INC | IN | General Acute Care Hospital (282N00000X) |
United | 428 | $5539.00 | 1255579389 - TEXAS REGIONAL MEDICAL CENTER, LLC, BAYLOR SCOTT & WHITE MEDICAL CENTER - SUNNYVALE | 510570864 - (TX) TEXAS REGIONAL MEDICAL CENTER, LTD | TX | General Acute Care Hospital (282N00000X) |
United | 428 | $87008.81 | 1760413777 - THEDACARE MEDICAL CENTER, COMMUNITY HEALTH NETWORK, INC AND BERLIN MEMORIAL HOSPITAL | 350983617 - COMMUNITY HEALTH NETWORK INC | WI | Critical Access Hospital (282NC0060X) |
United | 428 | $46983.00 | 1043292899 - METRO KNOXVILLE HMA LLC, TENNOVA HEALTHCARE NORTH KNOXVILLE MEDICAL CENTER | 452528414 | TN | General Acute Care Hospital (282N00000X) |
United | 428 | $65785.00 | 1205251204 - PROSPECT CHARTERCARE SJHSRI, LLC, SOUTHERN NEW ENGLAND REHABILITATION CENTER | 464661337 | RI | Rehabilitation Hospital Unit (273Y00000X) |
United | 428 | $38925.00 | 1396746129 - MEMORIAL HEALTH SYSTEM OF EAST TEXAS, CHI ST. LUKES HEALTH MEMORIAL LUFKIN | 750755367 - (TX) MEMORIAL HEALTH SYSTEM OF EAST TEXAS | TX | Rural Acute Care Hospital (282NR1301X) |
United | 428 | $145957.71 | 1558521070 - BANNER BOSWELL MEDICAL CENTER | 900389314 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 428 | $89204.95 | 1902865355 - GOOD SAMARITAN HOSPITAL MEDICAL CENTER | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 428 | $31976.00 | 1124137054 - ASCENSION SETON, ASCENSION SETON NORTHWEST | 741109643 - ASCENSION SETON | TX | General Acute Care Hospital (282N00000X) |
United | 428 | $26220.00 | 1124137054 - ASCENSION SETON, ASCENSION SETON NORTHWEST | 741109643 - ASCENSION SETON | TX | General Acute Care Hospital (282N00000X) |
United | 428 | $51276.19 | 1508859661 - MERCY HOSPITAL JEFFERSON, JEFFERSON MEMORIAL HOSPITAL ASSOCIATION | 430687077 - (MO) MERCY HOSPITAL JEFFERSON | MO | General Acute Care Hospital (282N00000X) |
United | 428 | $96024.53 | 1467129700 - VHS SAN ANTONIO PARTNERS, LLC, NORTHEAST BAPTIST HOSPITAL | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 428 | $70248.82 | 1265454391 - PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK, PRESENCE MERCY MEDICAL CENTER | 992367318 | IL | General Acute Care Hospital (282N00000X) |
United | 428 | $65785.00 | 1205251204 - PROSPECT CHARTERCARE SJHSRI, LLC, SOUTHERN NEW ENGLAND REHABILITATION CENTER | 464661337 | RI | Rehabilitation Hospital Unit (273Y00000X) |
United | 428 | $76011.61 | 1831868033 - VHS SAN ANTONIO PARTNERS, LLC, NORTH CENTRAL BAPTIST HOSPITAL | 760714523 | 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 428 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 428 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 428 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 |
|---|---|---|
| 427-APR-DRG | High | THYROID DISORDERS |
| 427-MS-DRG | High | Multiple Level Combined Anterior and Posterior Spinal Fusion except Cervical with CC |
| 428-MS-DRG | High | Multiple Level Combined Anterior and Posterior Spinal Fusion except Cervical without CC/MCC |
| 429-MS-DRG | High | Combined Anterior and Posterior Cervical Spinal Fusion with MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 428. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 428 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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