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 | $160832.70 | 1073664116 - PRESBYTERIAN HOSPITAL OF PLANO | 752770738 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO | TX | Psychiatric Hospital Unit (273R00000X) |
United | 430 | $58446.82 | 1538667035 - CARTHAGE HOSPITAL, LLC | 824005981 | TX | General Acute Care Hospital (282N00000X) |
United | 430 | $48370.16 | 1720861107 - PECOS COUNTY MEMORIAL HOSPITAL DISTRICT | 921628671 | TX | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 430 | $139174.98 | 1104957083 - INOVA HEALTH CARE SERVICES, INOVA MOUNT VERNON HOSPITAL | 540620889 - INOVA HEALTH CARE SERVICES | VA | Psychiatric Hospital Unit (273R00000X) |
United | 430 | $60823.00 | 1043328198 - WESTLAKE SURGICAL, L.P., THE HOSPITAL AT WESTLAKE MEDICAL CENTER | 820578078 - (TX) WESTLAKE SURGICAL L.P | TX | General Acute Care Hospital (282N00000X) |
United | 430 | $163020.90 | 1033889795 - PRISMA HEALTH-MIDLANDS, PRISMA HEALTH CANCER INST-RICHLAND | 582296052 - (SC) PRISMA HEALTH-MIDLANDS | SC | General Acute Care Hospital (282N00000X) |
United | 430 | $131313.87 | 1265529887 - MEMORIAL HOSPITAL-WEST VOLUSIA INC, ADVENTHEALTH DELAND | 593256803 - MEMORIAL HOSPITAL-WEST VOLUSIA INC | FL | Psychiatric Hospital Unit (273R00000X) |
United | 430 | $89032.39 | 1700281763 - MERCY HEALTH-REGIONAL MEDICAL CENTER LLC, MERCY REGIONAL MEDICAL CENTER | 340714704 | OH | Psychiatric Hospital Unit (273R00000X) |
United | 430 | $185493.70 | 1023028651 - BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER LLC, BON SECOURS MEMORIAL REGIONAL PRO FEE SEVICES | 541744931 - BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER LLC | VA | General Acute Care Hospital (282N00000X) |
United | 430 | $205663.45 | 1437575040 - WESTCHESTER COUNTY HEALTH CARE CORPORATION, MID-HUDSON VALLEY DIVISION OF WESTCHESTER MEDICAL CENTER | 133964321 - (NY) PEO MID-HUDSON VALLEY STAFFCO | NY | Psychiatric Hospital Unit (273R00000X) |
United | 430 | $52445.67 | 1700509577 - PRIME HEALTHCARE SERVICES PAMPA LLC | 455125687 - (TX) PRIME HEALTHCARE SERVICES PAMPA, LLC | TX | Critical Access Hospital (282NC0060X) |
United | 430 | $107095.97 | 1639320484 - PROVIDENCE HEALTH & SERVICES, PROV SCRED HRT MED CTR & CHLDS HOS | 364640211 | WA | Psychiatric Hospital Unit (273R00000X) |
United | 430 | $75804.71 | 1164485363 - ST MARY MEDICAL CENTER, OSF SAINT MARY MEDICAL CENTER | 370662581 | IL | 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 | $62817.75 | 1801062310 - INDIAN RIVER MEMORIAL HOSPITAL, INC., BEHAVIORAL HEALTH CENTER | 592496294 - INDIAN RIVER MEMORIAL HOSPITAL INC | FL | Psychiatric Hospital Unit (273R00000X) |
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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