MS-DRG 597 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 Skin, Subcutaneous Tissue & Breast |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 597 by major payers:
$19,682.13
$22,473.70
$27,415.92
$28,012.20
| 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 597 | ||||||
United | 597 | $29083.92 | 1871609396 - APPALACHIAN REGIONAL HEALTHCARE, INC, WHITESBURG ARH HOSPITAL | 520795508 - APPALACHIAN REGIONAL HEALTHCARE INC | KY | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 597 | $39107.66 | 1164507133 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 597 | $59464.30 | 1164529400 - VALLEY BAPTIST MEDICAL CENTER | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 597 | $17097.96 | 1134162746 - LONE STAR HMA L P, MESQUITE COMMUNITY HOSPITAL | 472177648 | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 597 | $25377.88 | 1881642809 - RIVER PARK HOSPITAL LLC, RIVER PARK HOSPITAL | 474063149 | TN | General Acute Care Hospital (282N00000X) |
United | 597 | $11042.00 | 1497900781 - MONMOUTH MEDICAL CENTER INC | 223452412 | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 597 | $25030.72 | 1811108822 - ADAMS COUNTY PUBLIC HOSPITAL DISTRICT 3, OTHELLO COMMUNITY HOSPITAL | 916016170 - (WA) ADAMS COUNTY PUBLIC HOSPITAL DISTRICT 3 | WA | Critical Access Hospital (282NC0060X) |
United | 597 | $6706.00 | 1245227180 - ST FRANCIS MEDICAL CENTER | 850737566 | CA | General Acute Care Hospital (282N00000X) |
United | 597 | $13968.00 | 1841624756 - PECONIC BAY MEDICAL CENTER | 111661359 - (NY) CENTRAL SUFFOLK HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 597 | $47228.87 | 1306004205 - GREENWICH HOSPITAL | 60646659 - (CT) GREENWICH HOSPITAL | CT | Rural Acute Care Hospital (282NR1301X) |
United | 597 | $46582.41 | 1841069044 - EAST COOPER MEDICAL CENTER LLC | 934555562 | SC | General Acute Care Hospital (282N00000X) |
United | 597 | $85449.53 | 1962472431 - COASTAL CAROLINA MEDICAL CENTER, INC., COASTAL CAROLINA HOSPITAL | 300151925 - (SC) COASTAL CAROLINA MEDICAL CENTER INC | SC | General Acute Care Hospital (282N00000X) |
United | 597 | $33196.35 | 1134223878 - PROVIDENCE EVERETT MEDICAL CENTER, INPATIENT REHABILITATION FACILITY | 352346161 | WA | Rehabilitation Hospital Unit (273Y00000X) |
United | 597 | $2360.00 | 1205832334 - MILLCREEK COMMUNITY HOSPITAL | 251002937 - (PA) MILLCREEK COMMUNITY HOSPITAL | PA | Psychiatric Hospital Unit (273R00000X) |
United | 597 | $21248.24 | 1073799664 - THEDACARE MEDICAL CENTER, RIVERSIDE MEDICAL CENTER, INC. | 390871113 - (WI) THEDACARE MEDICAL CENTER-WAUPACA INC | WI | 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 597 vs. Other Diseases & Disorders of the Skin, Subcutaneous Tissue & Breast Codes
The MS-DRG 597 code is part of the Diseases & Disorders of the Skin, Subcutaneous Tissue & Breast 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 597 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 |
|---|---|---|
| 596-APR-DRG | Moderate | Anoxic And Other Severe Brain Damage |
| 596-MS-DRG | High | Major Skin Disorders without MCC |
| 597-MS-DRG | High | Malignant Breast Disorders with MCC |
| 598-APR-DRG | Moderate | Anoxic And Other Severe Brain Damage |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 597. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 597 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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