MS-DRG 697 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 Kidney & Urinary Tract |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 697 by major payers:
$11,593.92
$13,232.09
$15,902.14
$16,235.83
| 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 697 | ||||||
United | 697 | $9285.19 | 1477516466 - SCOTT & WHITE MEMORIAL HOSPITAL, BAYLOR SCOTT & WHITE MEDICAL CENTER - TEMPLE | 741166904 - SCOTT & WHITE MEMORIAL HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 697 | $16845.26 | 1689679581 - ALLE-KISKI MEDICAL CENTER, ALLEGHENY VALLEY HOSPITAL | 251875178 - (PA) HIGHMARK HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 697 | $14773.05 | 1598829442 - METHODIST HEALTHCARE, METHODIST BEHAVIORAL HEALTH | 620479367 - METHODIST HEALTHCARE-MEMPHIS | TN | Psychiatric Hospital Unit (273R00000X) |
United | 697 | $13370.55 | 1326064452 - SOLIS HEALTHCARE, LP, ROXBOROUGH MEMORIAL HOSPITAL | 454246163 - (PA) PRIME HEALTHCARE SERVICES ROXBOROUGH, LLC | PA | Psychiatric Hospital Unit (273R00000X) |
United | 697 | $17349.16 | 1497792527 - UNIVERSITY HEALTHCARE SYSTEM, L.C., TULANE LAKESIDE HOSPITAL | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | 697 | $25505.83 | 1851847974 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-EASLEY | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 697 | $13529.73 | 1700901873 - EAST TEXAS MEDICAL CENTER REHABILITATION HOSPITAL | 823913174 | TX | Rehabilitation Hospital (283X00000X) |
United | 697 | $26024.69 | 1437102605 - HCA HEALTH SERVICES OF GEORGIA, INC., HUGHSTON ORTHOPEDIC HOSPITAL | 331216751 - (GA) HUGHSTON HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | 697 | $15423.87 | 1417005760 - UVA PRINCE WILLIAM MEDICAL CENTER, UVA HEALTH PRINCE WILLIAM MEDICAL CENTER | 540696355 - (VA) UVA PRINCE WILLIAM MEDICAL CENTER | VA | General Acute Care Hospital (282N00000X) |
United | 697 | $6893.02 | 1982678827 - KANSAS REHABILITATION HOSPITAL INC, KANSAS REHABILITATION HOSPITAL, A JOINT VENTURE OF ENCOMPASS HEALTH | 521535077 - (KS) KANSAS REHABILITATION HOSPITAL INC | KS | Rehabilitation Hospital (283X00000X) |
United | 697 | $15201.30 | 1144266024 - INDIANA UNIVERSITY HEALTH INC, INDIANA UNIVERSITY HEALTH | 351955872 - (IN) INDIANA UNIVERSITY HEALTH INC | IN | General Acute Care Hospital (282N00000X) |
United | 697 | $6706.00 | 1356410351 - PRIME HEALTHCARE PARADISE VALLEY LLC, PARADISE VALLEY HOSPITAL | 205837239 | CA | General Acute Care Hospital (282N00000X) |
United | 697 | $23619.11 | 1639108434 - WILLAMETTE FALLS HOSPITAL, PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER | 611659489 | OR | General Acute Care Hospital (282N00000X) |
United | 697 | $3727.00 | 1841257631 - TERREBONNE PARISH HOSPITAL SERVICE DISTRICT #1, TERREBONE GENERAL REHABILITATION UNIT | 720880258 - (LA) TERREBONNE HOSPITAL SERVICE DISTRICT NO 1 | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 697 | $16763.00 | 1164663365 - LONG ISLAND JEWISH MEDICAL CENTER | 112241326 - LONG ISLAND JEWISH MEDICAL CENTER | NY | 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 697 vs. Other Diseases & Disorders of the Kidney & Urinary Tract Codes
The MS-DRG 697 code is part of the Diseases & Disorders of the Kidney & Urinary Tract 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 697 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 |
|---|---|---|
| 696-APR-DRG | High | OTHER CHEMOTHERAPY |
| 696-MS-DRG | High | Kidney and Urological Tract Signs and Symptoms without MCC |
| 697-MS-DRG | High | Urethral Stricture |
| 698-MS-DRG | High | Other Kidney and Urological Tract Diagnoses 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 697. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 697 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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