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 | $5314.00 | 1669732178 - AD HOSPITAL EAST, LLC | 475587037 | TX | General Acute Care Hospital (282N00000X) |
United | 786 | $16133.00 | 1982632311 - SAINT VINCENT HEALTH CENTER | 250965547 - (PA) HIGHMARK HEALTH | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 786 | $27474.15 | 1386608859 - HONORHEALTH, SCOTTSDALE HEALTHCARE SHEA MEDICAL CENTER | 860181654 - HONORHEALTH | AZ | 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 | $11560.00 | 1780682161 - MERIDIAN HOSPITALS CORPORATION, RIVERVIEW MEDICAL CENTER- REHAB | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | Rehabilitation Hospital Unit (273Y00000X) |
United | 786 | $42099.82 | 1851944029 - UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS, UT SOUTHWESTERN INPATIENT REHABILITATION | 753175630 | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 786 | $42099.82 | 1851944029 - UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS, UT SOUTHWESTERN INPATIENT REHABILITATION | 753175630 | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 786 | $48153.82 | 1205889458 - PRISMA HEALTH-MIDLANDS, PRISMA HEALTH BAPTIST HOSPITAL | 582296052 - (SC) PRISMA HEALTH-MIDLANDS | SC | General Acute Care Hospital (282N00000X) |
United | 786 | $20791.00 | 1780682161 - MERIDIAN HOSPITALS CORPORATION, RIVERVIEW MEDICAL CENTER- REHAB | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | Rehabilitation Hospital Unit (273Y00000X) |
United | 786 | $50450.32 | 1922344167 - TEXAS HEALTH ARLINGTON MEMORIAL | 750972805 - (TX) TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 786 | $37724.46 | 1508859323 - PIH HEALTH GOOD SAMARITAN HOSPITAL, GOOD SAMARITAN HOSPITAL | 951656366 - (CA) PIH HEALTH GOOD SAMARITAN HOSPITAL | CA | General Acute Care Hospital (282N00000X) |
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 | $24794.00 | 1316061997 - UCSF HEALTH COMMUNITY HOSPITALS | 941156295 - (CA) SAINT FRANCIS MEMORIAL HOSPITAL | CA | General Acute Care Hospital (282N00000X) |
United | 786 | $14544.71 | 1932160082 - MARION REGIONAL MEDICAL CENTER, INC., MARION REGIONAL MEDICAL CENTER | 320583236 - MONROE HEALTH SERVICES INC | AL | General Acute Care Hospital (282N00000X) |
United | 786 | $8928.00 | 1487649430 - THE MIRIAM HOSPITAL | 50258905 - THE MIRIAM HOSPITAL | RI | 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 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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