MS-DRG 604 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 604 by major payers:
$16,091.57
$18,998.84
$23,332.26
$23,742.92
| 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 604 | ||||||
United | 604 | $39830.12 | 1457994188 - VHS HARLINGEN HOSPITAL COMPANY, LLC, VALLEY BAPTIST MICRO-HOSPITAL WESLACO | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 604 | $20169.85 | 1700828852 - THE METROHEALTH SYSTEM, METROHEALTH MEDICAL CENTER | 346004382 | OH | General Acute Care Hospital (282N00000X) |
United | 604 | $12638.51 | 1992775449 - CHRISTUS HEALTH CENTRAL LOUISIANA, CHRISTUS ST. FRANCES CABRINI HOSPITAL | 720408984 - (LA) CHRISTUS HEALTH CENTRAL LOUISIANA | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 604 | $38512.32 | 1174035604 - AHS HOSPITAL CORP. | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 604 | $34119.10 | 1922031541 - TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | 751752253 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | TX | General Acute Care Hospital (282N00000X) |
United | 604 | $5663.39 | 1629009964 - MERCY HEALTH YOUNGSTOWN LLC, MERCY HEALTH ST JOSEPH WARREN HOSPITAL | 340505560 - HUMILITY OF MARY HEALTH PARTNERS | OH | General Acute Care Hospital (282N00000X) |
United | 604 | $12794.00 | 1982650024 - HCA HEALTH SERVICES OF TENNESSEE, INC., TRISTAR SUMMIT MEDICAL CENTER | 621113737 - HCA HEALTH SERVICES OF TENNESSEE INC | TN | General Acute Care Hospital (282N00000X) |
United | 604 | $23780.10 | 1952359036 - NASH HOSPITALS INC, BRYANT T. ALDRIDGE REHABILITATION CENTER | 237027004 - (NC) NASH HOSPITALS INC | NC | Rehabilitation Hospital Unit (273Y00000X) |
United | 604 | $31241.59 | 1235162645 - NORCAL HEALTHCONNECT LLC, PETALUMA VALLEY HOSPITAL | 852390012 | CA | General Acute Care Hospital (282N00000X) |
United | 604 | $31241.59 | 1235162645 - NORCAL HEALTHCONNECT LLC, PETALUMA VALLEY HOSPITAL | 852390012 | CA | General Acute Care Hospital (282N00000X) |
United | 604 | $18000.00 | 1184400822 - DECATUR HEALTH SERVICES, LLC | 932081386 | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 604 | $14069.00 | 1114189636 - PHELPS MEMORIAL HOSPITAL ASSOCIATION, REHABILITATION SUB PROVIDER HOSPITAL | 131725076 - (NY) PHELPS MEMORIAL HOSPITAL ASSOCIATION | NY | Rehabilitation Hospital (283X00000X) |
United | 604 | $23732.57 | 1114972007 - CANNON COUNTY HOSPITAL LLC, STONES RIVER HOSPITAL | 474063232 | TN | General Acute Care Hospital (282N00000X) |
United | 604 | $26077.00 | 1023296357 - LOYOLA UNIVERSITY MEDICAL CENTER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Critical Access Hospital (282NC0060X) |
United | 604 | $13001.75 | 1487743340 - DLP RUTHERFORD REGIONAL HEALTH SYSTEM, LLC, RUTHERFORD REGIONAL MEDICAL CENTER - PSYCHIATRIC UNIT | 300811171 | NC | Psychiatric Hospital Unit (273R00000X) |
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 604 vs. Other Diseases & Disorders of the Skin, Subcutaneous Tissue & Breast Codes
The MS-DRG 604 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 604 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 |
|---|---|---|
| 603-APR-DRG | High | NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION |
| 603-MS-DRG | High | Cellulitis without MCC |
| 604-MS-DRG | High | Trauma to the Skin, Subcutaneous Tissue and Breast with MCC |
| 605-MS-DRG | High | Trauma to the Skin, Subcutaneous Tissue and Breast without 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 604. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 604 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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