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 | $14413.04 | 1427043546 - KATHERINE SHAW BETHEA HOSPITAL | 361000540 - (IL) KATHERINE SHAW BETHEA HOSPITAL | IL | 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 | $25897.63 | 1922031541 - TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | 751752253 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | TX | 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 | $2703.00 | 1639797913 - SINGING RIVER GULFPORT | 851538878 | MS | General Acute Care Hospital (282N00000X) |
United | 436 | $9486.09 | 1316994734 - MERCY HEALTH, HARNESS HEALTH PHARMACY | 344431174 - (OH) MERCY HEALTH - TIFFIN HOSPITAL LLC | OH | General Acute Care Hospital (282N00000X) |
United | 436 | $11193.55 | 1972071991 - GAINESVILLE COMMUNITY HOSPITAL, INC., NORTH TEXAS MEDICAL CENTER | 831683025 - (TX) GAINESVILLE COMMUNITY HOSPITAL INC | TX | General Acute Care Hospital (282N00000X) |
United | 436 | $19821.58 | 1124026273 - PROVIDENCE SAINT JOHN'S HEALTH CENTER | 951684082 - (CA) PROVIDENCE SAINT JOHNS HEALTH CENTER | CA | General Acute Care Hospital (282N00000X) |
United | 436 | $17510.66 | 1710097936 - OCHSNER MEDICAL CENTER | 205432782 | LA | General Acute Care Hospital (282N00000X) |
United | 436 | $12210.74 | 1417196015 - PROVIDENCE HOSPITAL | 381358212 - ASCENSION PROVIDENCE HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 436 | $12595.67 | 1255421210 - HIAWATHA HOSPITAL ASSOCIATION INC, AMBERWELL HIAWATHA | 480577658 - HIAWATHA HOSPITAL ASSOCIATION INC | KS | Critical Access Hospital (282NC0060X) |
United | 436 | $8241.00 | 1083621130 - PLAINVIEW HOSPITAL | 113241243 - (NY) PLAINVIEW HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 436 | $12301.37 | 1689776882 - ST CATHERINE HOSPITAL INC | 351738708 - (IN) ST CATHERINE HOSPITAL INC | IN | General Acute Care Hospital (282N00000X) |
United | 436 | $8598.00 | 1083612881 - ENGLEWOOD HOSPITAL AND MEDICAL CENTER | 221487173 - (NJ) ENGLEWOOD HOSPITAL AND MEDICAL CENTER A NEW JERSEY NONPROFIT CORP | NJ | General Acute Care Hospital (282N00000X) |
United | 436 | $14437.94 | 1538163886 - DAMERON HOSPITAL ASSOCIATION | 941201197 - (CA) DAMERON HOSPITAL ASSOCIATION | CA | 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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