MS-DRG 642 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 642 by major payers:
$15,159.67
$16,410.18
$19,551.94
$20,013.03
| 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 642 | ||||||
United | 642 | $13259.91 | 1720037559 - EAST TEXAS MEDICAL CENTER PITTSBURG, ETMC PITTSBURG | 823953636 | TX | Critical Access Hospital (282NC0060X) |
United | 642 | $29893.13 | 1164473039 - MARGARETVILLE MEMORIAL HOSPITAL | 150552726 - (NY) MARGARETVILLE MEMORIAL HOSPITAL | NY | Critical Access Hospital (282NC0060X) |
United | 642 | $20490.99 | 1588662357 - ALTOONA REGIONAL HEALTH SYSTEM, ALTOONA REGIONAL HEALTH SYSTEM | 231352155 - UPMC | PA | General Acute Care Hospital (282N00000X) |
United | 642 | $20883.15 | 1457550840 - , PROVIDENCE ST PETER HOSPITAL | 910567732 | WA | Psychiatric Hospital Unit (273R00000X) |
United | 642 | $30177.91 | 1841248713 - SUNY HEALTHSCIENCE CENTER AT SYRACUSE, UPSTATE MEDICAL UNIVERSITY | 161469571 | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 642 | $19038.47 | 1861432726 - OVERLAKE HOSPITAL MEDICAL CENTER | 910652651 - (WA) OVERLAKE HOSPITAL MEDICAL CENTER | WA | General Acute Care Hospital (282N00000X) |
United | 642 | $21882.22 | 1477539492 - MARY GREELEY MEDICAL CENTER | 421347891 | IA | General Acute Care Hospital (282N00000X) |
United | 642 | $21385.84 | 1760543342 - COVENANT HEALTH SYSTEM, COVENANT MEDICAL CENTER | 822913146 - (TX) COVENANT MEDICAL CENTER | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 642 | $18906.66 | 1336520840 - SAINT THOMAS STONES RIVER HOSPITAL, LLC, ASCENSION SAINT THOMAS STONES RIVER | 474063232 | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 642 | $15456.66 | 1619147824 - HEALTH & HOSPITAL CORPORATION OF MARION COUNTY, WISHARD HEALTH SERVICES | 356005697 | IN | General Acute Care Hospital (282N00000X) |
United | 642 | $24411.81 | 1003260480 - BBH BMC, LLC, BROOKWOOD MEDICAL CENTER | 474757851 | AL | General Acute Care Hospital (282N00000X) |
United | 642 | $30383.36 | 1154638336 - THE CLEVELAND CLINIC FOUNDATION, CLEVELAND CLINIC | 340714585 - THE CLEVELAND CLINIC FOUNDATION | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 642 | $13259.91 | 1720037559 - EAST TEXAS MEDICAL CENTER PITTSBURG, ETMC PITTSBURG | 823953636 | TX | Critical Access Hospital (282NC0060X) |
United | 642 | $20331.48 | 1801887658 - PORTLAND ADVENTIST MEDICAL CENTER, ADVENTIST HEALTH PORTLAND | 930429015 - (OR) PORTLAND ADVENTIST MEDICAL CENTER | OR | General Acute Care Hospital (282N00000X) |
United | 642 | $30177.91 | 1841248713 - SUNY HEALTHSCIENCE CENTER AT SYRACUSE, UPSTATE MEDICAL UNIVERSITY | 161469571 | NY | Rehabilitation Hospital Unit (273Y00000X) |
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 642 vs. Other Endocrine, Nutritional & Metabolic Diseases & Disorders Codes
The MS-DRG 642 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 642 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 |
|---|---|---|
| 641-MS-DRG | High | Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes without MCC |
| 642-MS-DRG | High | Inborn and Other Disorders of Metabolism |
| 643-MS-DRG | High | Endocrine Disorders with 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 642. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 642 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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