MS-DRG 795 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 795 by major payers:
$2,362.84
$3,951.71
$3,329.90
$2,915.16
| 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 795 | ||||||
United | 795 | $4370.81 | 1679678486 - MEMORIAL HOSPITAL FLAGLER INC, ADVENTHEALTH PALM COAST | 592951990 - MEMORIAL HOSPITAL FLAGLER INC | FL | General Acute Care Hospital (282N00000X) |
United | 795 | $962.03 | 1437253085 - CALHOUN LIBERTY HOSPITAL ASSOCIATION, INC., CALHOUN-LIBERTY HOSPITAL | 593051173 - (FL) CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC | FL | Critical Access Hospital (282NC0060X) |
United | 795 | $5096.50 | 1396117362 - MAIMONIDES MEDICAL CENTER | 111635081 - (NY) MAIMONIDES MEDICAL CENTER- | NY | General Acute Care Hospital (282N00000X) |
United | 795 | $4588.41 | 1457382798 - TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN | 752771437 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN | TX | General Acute Care Hospital (282N00000X) |
United | 795 | $9380.01 | 1164688495 - PREFERRED HOSPITAL LEASING JUNCTION, INC, KIMBLE HOSPITAL | 262294680 | TX | Critical Access Hospital (282NC0060X) |
United | 795 | $3429.96 | 1598766495 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER,INC | 720423635 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER INC | LA | General Acute Care Hospital (282N00000X) |
United | 795 | $4774.02 | 1750592754 - NORTHWEST PERMANENTE | 930386929 - (OR) PROVIDENCE HEALTH & SERVICES OREGON | OR | General Acute Care Hospital (282N00000X) |
United | 795 | $824.17 | 1023011657 - SWEENY HOSPITAL DISTRICT, SWEENY COMMUNITY HOSPITAL | 741498067 | TX | Critical Access Hospital (282NC0060X) |
United | 795 | $2622.17 | 1396927117 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH ST. JOSEPH HOSPITAL - ST, CHARLES | 431343281 - SSM HEALTH CARE ST LOUIS | MO | Rehabilitation Hospital Unit (273Y00000X) |
United | 795 | $6036.95 | 1225507114 - UNIVERSITY HOSPITAL AT STONY BROOK | 113243405 | NY | General Acute Care Hospital (282N00000X) |
United | 795 | $8335.00 | 1669578324 - NYU LANGONE HOSPITALS | 133971298 - NYU LANGONE HOSPITALS | NY | General Acute Care Hospital (282N00000X) |
United | 795 | $2049.00 | 1740252592 - VHS ACQUISITION SUBSIDIARY NUMBER 9 INC, METROWEST MEDICAL CENTER | 621861200 - (MA) VHS ACQUISITION SUBSIDIARY NUMBER 9 INC | MA | General Acute Care Hospital (282N00000X) |
United | 795 | $4009.59 | 1952359986 - SOUTHWESTERN MEDICAL CENTER, LLC, SOUTHWESTERN MEDICAL CENTER | 621757662 | OK | General Acute Care Hospital (282N00000X) |
United | 795 | $4924.18 | 1619938149 - SENTARA HOSPITALS, SENTARA WILLIAMSBURG REGIONAL MEDICAL CENTER | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 795 | $2389.81 | 1568548782 - CANTON-POTSDAM HOSPITAL | 161012691 - CANTON-POTSDAM HOSPITAL | NY | 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 795 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 795 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 795 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 |
|---|---|---|
| 794-APR-DRG | High | NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT |
| 794-MS-DRG | High | Neonate with Other Significant Problems |
| 795-MS-DRG | High | Normal Newborn |
| 796-MS-DRG | High | Vaginal Delivery with Sterilization and/or D&C with MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 795. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 795 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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