MS-DRG 786 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 786 by major payers:
$17,695.78
$15,532.10
$21,463.72
$25,500.39
| 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 786 | ||||||
United | 786 | $48824.42 | 1346391323 - SOUTHAMPTON HOSPITAL, SPORTS REHAB EAST HAMPOTN | 113243405 | NY | Rehabilitation Hospital (283X00000X) |
United | 786 | $25027.06 | 1003860487 - CLEVELAND CLINIC HEALTH SYSTEM, EUCLID HOSPITAL | 340714593 - CLEVELAND CLINIC HEALTH SYSTEM EAST REGION | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 786 | $10007.00 | 1689810327 - STATE OF MISSISSIPPI- UNIVERSITY OF MISSISSIPPI MEDICAL CENTER, UNIVERSITY OF MS MEDICAL CENTER | 646008520 | MS | Children's Hospital (282NC2000X) |
United | 786 | $12562.00 | 1043455199 - SISTERS OF CHARITY HOSPITAL, ST. JOSEPH CAMPUS | 160743187 - (NY) SISTERS OF CHARITY HOSPITAL OF BUFFALO NEW YORK | NY | General Acute Care Hospital (282N00000X) |
United | 786 | $38586.07 | 1164478442 - OSCEOLASC LLC, ST CLOUD REGIONAL MEDICAL CENTER | 203728235 - (FL) OSCEOLASC LLC | FL | General Acute Care Hospital (282N00000X) |
United | 786 | $9682.16 | 1578505095 - HOSPITAL DISTRICT NO 1 CRAWFORD COUNTY, GIRARD MEDICAL CENTER | 480698644 | KS | Critical Access Hospital (282NC0060X) |
United | 786 | $4784.00 | 1437211893 - SLIDELL MEMORIAL HOSPITAL, SLIDELL MEMORIAL HOSPITAL | 726014895 - (LA) SLIDELL MEMORIAL HOSPITAL | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 786 | $20231.69 | 1235256884 - EAST TEXAS MEDICAL CENTER | 823878395 | TX | General Acute Care Hospital (282N00000X) |
United | 786 | $40373.39 | 1619938149 - SENTARA HOSPITALS, SENTARA WILLIAMSBURG REGIONAL MEDICAL CENTER | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 786 | $6141.00 | 1285064907 - PRIME HEALTHCARE PARADISE VALLEY LLC, PARADISE VALLEY HOSPITAL | 205837239 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 786 | $11592.46 | 1760567515 - ALLIANCE COMMUNITY HOSPITAL | 340714581 - (OH) AULTMAN HEALTH FOUNDATION | OH | Psychiatric Hospital Unit (273R00000X) |
United | 786 | $10818.00 | 1275552747 - NORTHSHORE REGIONAL MEDICAL CENTER, LLC, NORTHSHORE REGIONAL MEDICAL CENTER | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 786 | $10523.00 | 1679678486 - MEMORIAL HOSPITAL FLAGLER INC, ADVENTHEALTH PALM COAST | 592951990 - MEMORIAL HOSPITAL FLAGLER INC | FL | General Acute Care Hospital (282N00000X) |
United | 786 | $31269.00 | 1467559997 - UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER, UCSF MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 786 | $9682.16 | 1578505095 - HOSPITAL DISTRICT NO 1 CRAWFORD COUNTY, GIRARD MEDICAL CENTER | 480698644 | KS | Critical Access Hospital (282NC0060X) |
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 786 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 786 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 786 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 |
|---|---|---|
| 785-MS-DRG | High | Cesarean Section with Sterilization without CC/MCC |
| 786-MS-DRG | High | Cesarean Section without Sterilization with MCC |
| 787-MS-DRG | High | Cesarean Section without Sterilization with CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 786. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 786 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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