MS-DRG 438 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 438 by major payers:
$19,211.49
$21,931.89
$26,348.50
$26,592.48
| 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 438 | ||||||
United | 438 | $38270.08 | 1669673463 - ALAMEDA HEALTH SYSTEM, HIGHLAND GENERAL HOSPITAL | 943302014 | CA | General Acute Care Hospital (282N00000X) |
United | 438 | $38270.08 | 1669673463 - ALAMEDA HEALTH SYSTEM, HIGHLAND GENERAL HOSPITAL | 943302014 | CA | General Acute Care Hospital (282N00000X) |
United | 438 | $21187.22 | 1740347087 - NORTHWEST TEXAS HEALTHCARE SYSTEM INC, NORTHWEST TEXAS HEALTHCARE SYSTEM | 232238976 | TX | Psychiatric Hospital Unit (273R00000X) |
United | 438 | $29738.01 | 1528463080 - PRIME HEALTHCARE SERVICES KANSAS CITY, LLC, ST. JOSEPH MEDICAL CENTER | 471669781 - (MO) PRIME HEALTHCARE SERVICES - KANSAS CITY LLC | MO | General Acute Care Hospital (282N00000X) |
United | 438 | $37152.55 | 1548248321 - STATE UNIVERSITY OF IOWA, UNIVERSITY OF IOWA HOSPITALS & CLINICS-PSYCHIATRIC MENTAL HEALTH UNIT | 426004813 | IA | Psychiatric Hospital Unit (273R00000X) |
United | 438 | $19524.96 | 1669538047 - UVA CULPEPER MEDICAL CENTER, UVA CULPEPER MEDICAL CENTER | 540622371 - (VA) UVA CULPEPER MEDICAL CENTER | VA | General Acute Care Hospital (282N00000X) |
United | 438 | $36596.41 | 1144471715 - PROVIDENCE HEALTH & SERVICES, PROV SCRED HRT MED CTR & CHLDS HOS | 364640211 | WA | General Acute Care Hospital (282N00000X) |
United | 438 | $21313.66 | 1235236779 - MERCY HOSPITALS EAST COMMUNITIES, MERCY HOSPITAL ST LOUIS | 430653493 - MERCY HOSPITALS EAST COMMUNITIES | MO | Rehabilitation Hospital Unit (273Y00000X) |
United | 438 | $6987.54 | 1912420928 - LEFLORE COUNTY HOSPITAL AUTHORITY, SWING BED | 736060835 - (OK) LEFLORE COUNTY HOSPITAL AUTHORITY | OK | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 438 | $3800.00 | 1215190202 - HARRIS COUNTY HOSPITAL DISTRICT BEN TAUB | 741536936 | TX | General Acute Care Hospital (282N00000X) |
United | 438 | $3800.00 | 1215190202 - HARRIS COUNTY HOSPITAL DISTRICT BEN TAUB | 741536936 | TX | General Acute Care Hospital (282N00000X) |
United | 438 | $22920.78 | 1730383084 - THE BROOKDALE HOSPITAL MEDICAL CENTER | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 438 | $37489.82 | 1508877689 - PROVIDENCE HEALTH & SERVICES WASHINGTON, PROVIDENCE ST. PETER HOSPITAL | 910567732 | WA | Psychiatric Hospital Unit (273R00000X) |
United | 438 | $20337.07 | 1568097897 - COX BARTON COUNTY HOSPITAL | 823300758 - (MO) COX BARTON COUNTY HOSPITAL | MO | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 438 | $19258.69 | 1932192465 - GOVE COUNTY MEDICAL CENTER | 486065840 - (KS) GOVE COUNTY MEDICAL CENTER | KS | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
MS-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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like MS-DRG 438) and we'll show you how you compare in 15 minutes or less.