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See a sample rate comparisonMS-DRG 794 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.
NEONATE WITH OTHER SIGNIFICANT 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 794 by major payers:
$6,253.66
$17,615.07
$22,820.09
$19,755.28
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MS-DRG 794
5 of 25 sample ratesHigher to lower in this preview
Oconee Medical Center
Prisma Health - Upstate
$37,584.05Published rateSt James Hospital And Health Center
Franciscan Health Olympia Fields
$19,766.32Published rateResilience Healthcare, Louis A. Weiss Memorial Hospital
$14,806.29Published rateSeiling Municipal Hospital Authority
$9,357.62Published rateUhs-Corona Inc, Corona Regional Medical Center
$4,063.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 794 vs. Other Newborns & Other Neonates with Conditions Originating in Perinatal Period Codes
The MS-DRG 794 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 794 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 |
|---|---|---|
| 793-APR-DRG | High | MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT |
| 793-MS-DRG | High | FULL TERM NEONATE WITH MAJOR PROBLEMS |
| 794-MS-DRG | High | NEONATE WITH OTHER SIGNIFICANT PROBLEMS |
| 795-MS-DRG | High | NORMAL NEWBORN |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 794. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 794 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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