MS-DRG 791 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 791 by major payers:
$23,524.87
$47,397.66
$63,274.94
$53,203.36
| 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 791 | ||||||
United | 791 | $68348.42 | 1730195017 - AMERICAN ONCOLOGIC HOSPITAL | 231352156 - (PA) THE AMERICAN ONCOLOGIC HOSPITAL | PA | Special Hospital (284300000X) |
United | 791 | $2331.00 | 1790860856 - CARONDELET HEALTH NETWORK, ST JOSEPH'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 791 | $63157.85 | 1871049973 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH GREENVILLE MEM SUB-ACUTE | 811723202 - PRISMA HEALTH - UPSTATE | SC | Special Hospital (284300000X) |
United | 791 | $43042.19 | 1215534466 - COVENANT HOSPITAL HOBBS, COVENANT HEALTH HOBBS HOSPITAL | 621760149 | NM | General Acute Care Hospital (282N00000X) |
United | 791 | $65672.93 | 1003864810 - CENTRAL DUPAGE HOSPITAL ASSOCIATION, NORTHWESTERN MEDICINE CENTRAL DUPAGE HOSPITAL | 370960170 - (IL) NORTHWESTERN MEMORIAL HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 791 | $73647.96 | 1790285500 - COMMUNITY HEALTH NETWORK REHABILITATION HOSPITAL SOUTH, LLC, COMMUNITY HEALTH NETWORK REHABILITATION HOSPITAL SOUTH | 821385366 - (IN) COMMUNITY HEALTH NETWORK REHABILITATION HOSPITAL SOUTH LLC | IN | Rehabilitation Hospital (283X00000X) |
United | 791 | $34455.28 | 1316924913 - WYOMING COUNTY | 166002571 | NY | Rural Acute Care Hospital (282NR1301X) |
United | 791 | $35195.46 | 1740273994 - ECTOR COUNTY HOSPITAL DISTRICT, MEDICAL CENTER HOSPITAL | 752302928 | TX | General Acute Care Hospital (282N00000X) |
United | 791 | $70838.13 | 1073555462 - CLARKE COUNTY PUBLIC HOSPITAL, CLARKE COUNTY HOSPITAL | 426037982 | IA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 791 | $83837.49 | 1386020402 - DECATUR MEMORIAL HOSPITAL | 370661199 - DECATUR MEMORIAL HOSPITAL | IL | Psychiatric Hospital Unit (273R00000X) |
United | 791 | $2331.00 | 1790860856 - CARONDELET HEALTH NETWORK, ST JOSEPH'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 791 | $43883.46 | 1801889969 - INDIANA REGIONAL MEDICAL CENTER | 250965404 - (PA) INDIANA REGIONAL MEDICAL CENTER | PA | Psychiatric Hospital Unit (273R00000X) |
United | 791 | $97973.50 | 1801059415 - NORTH COLORADO MEDICAL CENTER | 841287638 | CO | General Acute Care Hospital (282N00000X) |
United | 791 | $24854.55 | 1437102639 - COLUMBIA MEDICAL CENTER OF MCKINNEY SUBSIDIARY LP, MEDICAL CITY MCKINNEY | 621682207 - (TX) COLUMBIA MEDICAL CENTER OF MCKINNEY SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 791 | $43042.19 | 1215534466 - COVENANT HOSPITAL HOBBS, COVENANT HEALTH HOBBS HOSPITAL | 621760149 | NM | 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 791 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 791 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 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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