MS-DRG 638 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 | • Endocrine, Nutritional & Metabolic Diseases & Disorders |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 638 by major payers:
$10,305.14
$12,730.69
$14,506.58
$14,864.90
| 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 638 | ||||||
United | 638 | $10593.59 | 1700874062 - RIVERSIDE MEDICAL CENTER, RIVERSIDE MEDICAL CENTER | 720629905 - (LA) RIVERSIDE MEDICAL CENTER | LA | Critical Access Hospital (282NC0060X) |
United | 638 | $16877.89 | 1730710898 - FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC, FROEDTERT COMMUNITY HOSPITAL | 843381796 | WI | General Acute Care Hospital (282N00000X) |
United | 638 | $12808.87 | 1053362624 - RIPON MEDICAL CENTER INC, SSM HEALTH RIPON COMMUNITY HOSPITAL | 391101287 - RIPON MEDICAL CENTER INC | WI | Critical Access Hospital (282NC0060X) |
United | 638 | $15588.41 | 1811486764 - UPSTATE AFFILIATE ORGANIZATION, GHS CENTER FOR PSYCHIATRY | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 638 | $23893.06 | 1548399736 - DOCTORS MEDICAL CENTER OF MODESTO, INC., DOCTORS BEHAVIORAL HEALTH CENTER | 752918774 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 638 | $6714.81 | 1306825997 - WILLIAM BEAUMONT HOSPITAL, BEAUMONT HOSPITAL, TROY | 381459362 - WILLIAM BEAUMONT HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 638 | $10082.78 | 1801971916 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 638 | $25862.28 | 1033681630 - SPARTANBURG MEDICAL CENTER | 576000934 | SC | Psychiatric Hospital Unit (273R00000X) |
United | 638 | $7299.08 | 1033117635 - GUTHRIE CORTLAND MEDICAL CENTER | 150532079 - (NY) GUTHRIE CORTLAND MEDICAL CENTER | NY | Psychiatric Hospital Unit (273R00000X) |
United | 638 | $8192.51 | 1467485003 - HANCOCK REGIONAL HOSPITAL, HANCOCK REGIONAL HOSPITAL | 351092610 - (IN) HANCOCK REGIONAL HOSPITAL | IN | General Acute Care Hospital (282N00000X) |
United | 638 | $15804.26 | 1629053509 - PRESBYTERIAN HEALTHCARE SERVICES, PLAINS REGIONAL MEDICAL CENTER | 850105601 - PRESBYTERIAN HEALTHCARE SERVICES | NM | Rural Acute Care Hospital (282NR1301X) |
United | 638 | $22109.10 | 1821259185 - BANNER DEL E WEBB MEDICAL CENTER | 900389312 - (AZ) BANNER DEL E WEBB MEDICAL CENTER | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 638 | $7829.22 | 1639151301 - CAMPBELL COUNTY HMA, LLC, TENNOVA HEALTHCARE-LAFOLLETTE MEDICAL CENTER | 452528273 - CAMPBELL COUNTY HMA LLC | TN | General Acute Care Hospital (282N00000X) |
United | 638 | $25862.28 | 1033681630 - SPARTANBURG MEDICAL CENTER | 576000934 | SC | Psychiatric Hospital Unit (273R00000X) |
United | 638 | $7098.95 | 1477509859 - PHYSICIANS MEDICAL CENTER, LLC | 721275428 - (LA) PHYSICIANS MEDICAL CENTER, LLC | LA | General Acute Care Hospital (282N00000X) |
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 638 vs. Other Endocrine, Nutritional & Metabolic Diseases & Disorders Codes
The MS-DRG 638 code is part of the Endocrine, Nutritional & Metabolic Diseases & Disorders 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 638 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 |
|---|---|---|
| 637-MS-DRG | High | Diabetes with MCC |
| 638-MS-DRG | High | Diabetes with CC |
| 639-APR-DRG | High | NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION |
| 639-MS-DRG | High | Diabetes without CC/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 638. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 638 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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