MS-DRG 437 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 437 by major payers:
$10,801.31
$11,338.37
$12,579.84
$12,928.36
| 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 437 | ||||||
United | 437 | $12130.55 | 1225499379 - PROSPECT CCMC, LLC | 811507712 | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 437 | $11427.01 | 1689038408 - THEDACARE REGIONAL MEDICAL CENTER, APPLETON MEDICAL CENTER, INC. | 390824015 - (WI) THEDACARE REGIONAL MEDICAL CENTER- APPLETON INC | WI | General Acute Care Hospital (282N00000X) |
United | 437 | $19976.26 | 1285786228 - INOVA HEALTH CARE SERVICES, INOVA LOUDOUN HOSPITAL | 540620889 - INOVA HEALTH CARE SERVICES | VA | Psychiatric Hospital Unit (273R00000X) |
United | 437 | $12130.55 | 1225499379 - PROSPECT CCMC, LLC | 811507712 | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 437 | $9037.65 | 1255532875 - HUDSON HOSPITAL, INC. | 390804125 - HUDSON HOSPITAL INC | WI | Critical Access Hospital (282NC0060X) |
United | 437 | $15893.23 | 1619351160 - UCHEALTH GRANDVIEW HOSPITAL, UCHEALTH COLORADO SPRINGS HOSPITAL LLC | 473455146 - (CO) UCHEALTH GRANDVIEW HOSPITAL | CO | General Acute Care Hospital (282N00000X) |
United | 437 | $11606.83 | 1710039508 - THE METHODIST HOSPITALS, INC. | 350868133 - METHODIST HOSPITALS INC | IN | Rehabilitation Hospital Unit (273Y00000X) |
United | 437 | $13550.46 | 1639422504 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL SCHERTZ | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 437 | $7888.12 | 1083601330 - WESTERN MISSOURI MEDICAL CENTER | 440665266 - (MO) WESTERN MISSOURI MEDICAL CENTER | MO | General Acute Care Hospital (282N00000X) |
United | 437 | $14882.50 | 1760408801 - AMISUB (SFH), INC., ST. FRANCIS HOSPITAL | 752522262 | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 437 | $14882.50 | 1760408801 - AMISUB (SFH), INC., ST. FRANCIS HOSPITAL | 752522262 | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 437 | $5871.72 | 1417941295 - UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER | 756001354 | TX | General Acute Care Hospital (282N00000X) |
United | 437 | $5871.72 | 1417941295 - UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER | 756001354 | TX | General Acute Care Hospital (282N00000X) |
United | 437 | $19220.25 | 1760446009 - SIERRA VISTA HOSPITAL 69 | 850422820 | NM | Critical Access Hospital (282NC0060X) |
United | 437 | $19220.25 | 1760446009 - SIERRA VISTA HOSPITAL 69 | 850422820 | NM | Critical Access Hospital (282NC0060X) |
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 437 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 437 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 437 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 |
|---|---|---|
| 436-APR-DRG | Moderate | Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies |
| 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 |
| 438-APR-DRG | Moderate | Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 437. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 437 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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