MS-DRG 430 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 430 by major payers:
$61,545.79
$77,037.63
$80,441.07
$89,181.81
| 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 430 | ||||||
United | 430 | $55235.64 | 1326485749 - SOUTHERN REGIONAL MEDICAL CORPORATION, LEONARD J. CHABERT MEDICAL CENTER | 462743282 | LA | General Acute Care Hospital (282N00000X) |
United | 430 | $22976.09 | 1184997447 - LEFLORE COUNTY HOSPITAL AUTHORITY, MOUNTAIN GATEWAY SENIOR HEALTH | 736060835 - (OK) LEFLORE COUNTY HOSPITAL AUTHORITY | OK | Psychiatric Hospital Unit (273R00000X) |
United | 430 | $43691.00 | 1013116060 - GOOD SAMARITAN HOSPITAL, INC., ST. MARY'S GOOD SAMARITAN HOSPITAL | 261720984 - (GA) GOOD SAMARITAN HOSPITAL INC | GA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 430 | $81953.56 | 1538382239 - MEMORIAL HERMANN HEALTH SYSTEM, MEMORIAL HERMANN MEMORIAL CITY CICD | 741152597 - (TX) MEMORIAL HERMANN HEALTH SYSTEM | TX | General Acute Care Hospital (282N00000X) |
United | 430 | $113452.70 | 1346247350 - SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER INC, SOUTHEASTERN MED | 314391798 - (OH) SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER INC | OH | Rural Acute Care Hospital (282NR1301X) |
United | 430 | $112473.47 | 1265517759 - ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM, THE ARCHBISHOP BERGAN MERCY HOSPITAL | 470484764 - ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM | IA | General Acute Care Hospital (282N00000X) |
United | 430 | $10278.00 | 1023875424 - CHILDREN'S HOSPITAL COLORADO | 840166760 - CHILDRENS HOSPITAL COLORADO | CO | Children's Hospital (282NC2000X) |
United | 430 | $53305.00 | 1063406551 - COUNTY OF SANTA CLARA, INPATIENT ACUTE/OUTPATIENT FACILITY SERVICES | 946000533 | CA | General Acute Care Hospital (282N00000X) |
United | 430 | $57675.00 | 1336244474 - UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, UCSF MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 430 | $57675.00 | 1336244474 - UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, UCSF MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 430 | $52128.39 | 1740876382 - DELTA HEALTH SYSTEM, DELTA HEALTH-NORTHWEST REGIONAL | 853959101 | MS | General Acute Care Hospital (282N00000X) |
United | 430 | $52128.39 | 1740876382 - DELTA HEALTH SYSTEM, DELTA HEALTH-NORTHWEST REGIONAL | 853959101 | MS | General Acute Care Hospital (282N00000X) |
United | 430 | $99606.85 | 1649980137 - UCH-MHS | 460796114 - (CO) UCH-MHS | CO | General Acute Care Hospital (282N00000X) |
United | 430 | $212430.45 | 1245248939 - MOUNT SINAI HOSPITAL, MOUNT SINAI OF QUEENS | 131624096 - MOUNT SINAI HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 430 | $55235.64 | 1326485749 - SOUTHERN REGIONAL MEDICAL CORPORATION, LEONARD J. CHABERT MEDICAL CENTER | 462743282 | LA | 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 430 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 430 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 430 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 |
|---|---|---|
| 429-MS-DRG | High | Combined Anterior and Posterior Cervical Spinal Fusion with MCC |
| 430-MS-DRG | High | Combined Anterior and Posterior Cervical Spinal Fusion without MCC |
| 432-APR-DRG | Moderate | Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies |
| 432-MS-DRG | High | Cirrhosis and Alcoholic Hepatitis 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 430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 430 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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