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See a sample rate comparisonMS-DRG 438 Fee Schedule
Last Verified: October 2026
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.
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC
| 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 438 by major payers:
$19,211.49
$21,931.89
$26,348.50
$26,592.48
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MS-DRG 438
5 of 25 sample ratesHigher to lower in this preview
Washington Hospital Center
Washington Hospital Center Corporation
$42,344.91Published ratePrime Healthcare Services Kansas City, LLC, St. Joseph Medical Center
Prime Healthcare Services - Kansas City LLC
$29,738.01Published rateLester E Cox Medical Centers, Cox Medical Centers Meyer Orthopedic And Rehabilitation Hospital
Lester E Cox Medical Center
$20,337.07Published rateFannin County Hospital Authority, Dba Tmc Bonham Hospital
$10,847.20Published rateNorth Mississippi Medical Center, Inc., North Mississippi Medical Center
North Mississippi Medical Center Inc
$1,875.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 438 vs. Other Diseases & Disorders of the Hepatobiliary System & Pancreas Codes
The MS-DRG 438 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 438 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 |
|---|---|---|
| 437-MS-DRG | High | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC |
| 438-MS-DRG | High | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC |
| 439-APR-DRG | Moderate | Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies |
| 439-MS-DRG | High | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 438. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 438 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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