MS-DRG 436 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 436 by major payers:
$13,754.97
$15,059.22
$17,796.83
$18,300.03
| 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 436 | ||||||
United | 436 | $15173.20 | 1184622847 - CHI ST. LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER | 741161938 - CHI ST LUKES HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 436 | $24161.31 | 1164487542 - INSPIRA MEDICAL CENTERS, INC., INSPIRA MEDICAL CENTER VINELAND | 210634484 - (NJ) INSPIRA MEDICAL CENTERS INC | NJ | General Acute Care Hospital (282N00000X) |
United | 436 | $31732.23 | 1316361025 - TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN, TEXAS HEALTH KAUFMAN MIDWIFE CARE CENTER | 752771437 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN | TX | General Acute Care Hospital (282N00000X) |
United | 436 | $20847.78 | 1467484972 - OHIOHEALTH CORPORATION, RIVERSIDE METHODIST HOSPITAL | 314394942 - OHIOHEALTH CORPORATION GRANT RIVERSIDE DOCTORS DUBLIN MET | OH | General Acute Care Hospital (282N00000X) |
United | 436 | $15415.66 | 1679660617 - UNIVERSITY OF MIAMI HOSPITAL AND CLINICS, SYLVESTER COMPREHENSIVE CANCER CENTER | 592616017 | FL | Special Hospital (284300000X) |
United | 436 | $27053.51 | 1376624981 - PROVIDENCE HEALTH & SERVICES WASHINGTON, PROVIDENCE CENTRALIA HOSPITAL | 352346161 | WA | General Acute Care Hospital (282N00000X) |
United | 436 | $27653.46 | 1124194063 - THE FAUQUIER HOSPITAL INC, BLACKWELL ROAD LOCATION | 463107896 | VA | General Acute Care Hospital (282N00000X) |
United | 436 | $28711.24 | 1225583115 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH ROGER C PEACE REHABILITATION HOSPITAL | 811723202 - PRISMA HEALTH - UPSTATE | SC | Rehabilitation Hospital (283X00000X) |
United | 436 | $32785.62 | 1437119310 - SENTARA HOSPITALS, SENTARA NORFOLK GENERAL HOSPITAL | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 436 | $8241.00 | 1083621130 - PLAINVIEW HOSPITAL | 113241243 - (NY) PLAINVIEW HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 436 | $15415.66 | 1679660617 - UNIVERSITY OF MIAMI HOSPITAL AND CLINICS, SYLVESTER COMPREHENSIVE CANCER CENTER | 592616017 | FL | Special Hospital (284300000X) |
United | 436 | $32784.21 | 1205181120 - HOSPITAL FOR SPECIAL SURGERY- NP | 131624135 - NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING | NY | Special Hospital (284300000X) |
United | 436 | $26046.47 | 1245220300 - KERSHAW HOSPITAL LLC | 571098556 - (SC) MEDICAL UNIVERSITY HOSPITAL AUTHORITY | SC | General Acute Care Hospital (282N00000X) |
United | 436 | $11254.45 | 1588784649 - CHRISTUS HEALTH SOUTHWESTERN LOUISIANA, CHRISTUS ST. PATRICK HOSPITAL | 720411322 - (LA) CHRISTUS HEALTH SOUTHWESTERN LOUISIANA | LA | General Acute Care Hospital (282N00000X) |
United | 436 | $3183.00 | 1376591941 - HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH, LANE REGIONAL MEDICAL CENTER | 726015227 | 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 436 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 436 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 436 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 |
|---|---|---|
| 435-APR-DRG | Moderate | Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies |
| 435-MS-DRG | High | Malignancy of Hepatobiliary System or Pancreas with MCC |
| 436-MS-DRG | High | Malignancy of Hepatobiliary System or Pancreas with CC |
| 437-MS-DRG | High | Malignancy of Hepatobiliary System or Pancreas without CC/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 436. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 436 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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