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See a sample rate comparisonMS-DRG 791 Fee Schedule
Last Verified: October 2026
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.
PREMATURITY WITH MAJOR PROBLEMS
| Key Fact | Detail |
|---|---|
| Service Type | Newborns & Other Neonates with Conditions Originating in Perinatal Period |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 791 by major payers:
$23,524.87
$47,397.66
$63,274.94
$53,203.36
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MS-DRG 791
5 of 25 sample ratesHigher to lower in this preview
North Colorado Medical Center
$97,973.50Published rateAmerican Oncologic Hospital
The American Oncologic Hospital
$68,348.42Published rateNYU Langone Hospitals, NYU Langone Hospital Long Island
NYU Langone Hospitals
$52,344.28Published rateCovenant Hospital Hobbs, Covenant Health Hobbs Hospital
$43,042.19Published rateCarondelet Health Network, St Joseph'S Hospital
$2,331.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 791 vs. Other Newborns & Other Neonates with Conditions Originating in Perinatal Period Codes
The MS-DRG 791 code is part of the Newborns & Other Neonates with Conditions Originating in Perinatal Period 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 791 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 |
|---|---|---|
| 790-MS-DRG | High | EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE |
| 791-MS-DRG | High | PREMATURITY WITH MAJOR PROBLEMS |
| 792-APR-DRG | High | EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT |
| 792-MS-DRG | High | PREMATURITY WITHOUT MAJOR PROBLEMS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 791. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 791 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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