MS-DRG 785 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 | • Pregnancy, Childbirth & the Puerperium |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 785 by major payers:
$10,369.47
$11,269.52
$13,831.88
$14,312.51
| 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 785 | ||||||
United | 785 | $6232.00 | 1275553539 - HOSPITAL SERVICE DISTRICT NO. 3, THIBODAUX REGIONAL MEDICAL CENTER | 842046902 - (LA) THIBODAUX REGIONAL HEALTH SYSTEM INC | LA | General Acute Care Hospital (282N00000X) |
United | 785 | $23716.40 | 1043462013 - GADSDEN REGIONAL MEDICAL CENTER LLC, GADSDEN REGIONAL MEDICAL CENTER | 631102774 | AL | General Acute Care Hospital (282N00000X) |
United | 785 | $8071.00 | 1952900920 - VANDERBILT BEDFORD HOSPITAL, LLC, VANDERBILT BEDFORD HOSPITAL | 853419620 | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 785 | $9572.00 | 1124346754 - INTEGRIS BAPTIST MEDICAL CENTER INC, INTEGRIS MENTAL HEALTH CENTER | 731034824 - (OK) INTEGRIS BAPTIST MEDICAL CENTER INC | OK | Psychiatric Hospital Unit (273R00000X) |
United | 785 | $18323.00 | 1619072006 - PINNACLE HEALTH HOSPITALS, PINNACLE HEALTH HOSPITAL INPATIENT AND OUTPATIENT | 251778644 - (PA) UPMC PINNACLE HOSPITALS | PA | General Acute Care Hospital (282N00000X) |
United | 785 | $30155.83 | 1780196345 - THE NEW YORK AND PRESBYTERIAN HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 785 | $17428.00 | 1528064409 - VIRTUA | 210634532 - VIRTU-WEST JERSEY HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 785 | $12261.00 | 1376574277 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL FORSYTH | 581954432 - (GA) NORTHSIDE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | 785 | $20602.00 | 1699861914 - KENNEDY MEMORIAL HOSPITALS-UNIVERSITY MEDICAL CENTER | 221773439 - (NJ) KENNEDY UNIVERSITY HOSPITAL INC | NJ | Substance Use Disorder Rehabilitation Hospital Unit (276400000X) |
United | 785 | $5820.00 | 1649488511 - TOURO INFIRMARY ANESTHESIA SERVICES | 720423659 - (LA) TOURO INFIRMARY | LA | General Acute Care Hospital (282N00000X) |
United | 785 | $10171.91 | 1881792547 - MERCY HOSPITALS EAST COMMUNITIES, MERCY HOSPITAL ST LOUIS | 430653493 - MERCY HOSPITALS EAST COMMUNITIES | MO | Psychiatric Hospital Unit (273R00000X) |
United | 785 | $23716.40 | 1043462013 - GADSDEN REGIONAL MEDICAL CENTER LLC, GADSDEN REGIONAL MEDICAL CENTER | 631102774 | AL | General Acute Care Hospital (282N00000X) |
United | 785 | $6858.25 | 1891873337 - CLHG, MINDEN MEDICAL CENTER | 824625698 | LA | Rural Acute Care Hospital (282NR1301X) |
United | 785 | $15226.84 | 1003832098 - NASSAU HEALTH CARE CORPORATION, NUMC -DEPARTMENT OF PM&R, FPP | 113465690 | NY | General Acute Care Hospital (282N00000X) |
United | 785 | $6141.00 | 1598756710 - PARADISE VALLEY HOSPITAL | 205837239 | CA | 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 785 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 785 code is part of the Pregnancy, Childbirth & the Puerperium 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 785 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 |
|---|---|---|
| 784-MS-DRG | High | Cesarean Section with Sterilization with CC |
| 785-MS-DRG | High | Cesarean Section with Sterilization without CC/MCC |
| 786-MS-DRG | High | Cesarean Section without Sterilization 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 785. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 785 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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